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3260W. Gantline Rd. Record ID# PR0526647 <br /> 9/10/2020 Program: HW <br /> Photo 11: The following uniform hazardous waste manifest(006391471 SKS) observed with no signed designated facility copy. <br /> rormrWPmve d PNB No.2050-0639 <br /> I.mrrhl rYFewnrerl <br /> C` •'figC" �. tln[ Y NumtM! <br /> `:gM7sF:a�CP�` zaamZw n `r°'- nN p46391�; SKS <br /> �` 8, n °7Y==�� '��f<�t ���� 0 - m oernrv�ds sioa aaenss{a aalaar�t man m.nlaa eadraul <br /> a `s_a` z. 'e:-Ya``k9 "l:enHtde.- r.�.. <br /> a' ^fc Like <br /> - -8-` <br /> JYE =S r.A 9531714-(1e1�.7 <br /> _: ,.,. 's: -':fT -f.°/�•'�-:: <br /> -x'1::9' `°6;f;.. %,;`: :_ •`t;".s( EGA 9° - L` �� v ,,,ra.,,n,..e rIVS"I"EMB FNC l%R6PJ1r0F41... <br /> C - / - yY •e � 3 d t'�h s,q o U,S.FfA1G Number <br /> F �FSiF, ``ice -n L �ua\FW��q r�pigrY LtvrFBnYNam� M�DRI:J� Y2J�' <br /> .:�59"ag 5 f! �plaOr.3 ENVIRONMENTAL FUC IW:. <br /> �$ �S eoa>;�a,er.•a Fa�rr Nem..w sundtlreee eLEPN hAR6CIR5 ENUIRUNME.NTPL 0FRVICE5, Mu.s.EPA to r+emne! <br /> 2,047 5 HIGHWAY 71 0 <br /> KIMBAI-I- i�'E". 69155 pIE'p9?172.35M1 .7 <br /> b 509-235-40t:_= <br /> r case, nl <br /> pz ys. 8b.u.s.nor 0e-om{indu*g Pryer siappvg Nemec H=rd Glass.to HbMbft 10.Coma— 11,TOGl 12.U'M 13.Waste Codas <br /> Y Ns, aMParp Gmp vl.mo) No, Typo Q—MyI WtNol. <br /> ''-lqo iF.O1- NON RCRA HAZARDOU6 WASTE LI DUI M ( r' p1 <br /> iYCOL "Hr:R, WATERS,-AXCI <br /> d c� <br /> 3. <br /> e4.. <br /> F� <br /> I � <br /> M1� 14.Spe f Haadlurg lra—iron awAddboml lnfurme6on [� } ($ <br /> AstfP 'r'%7EA@91 ILEI a85 <br /> o 24H gene: tfers aVr'ry a <br /> s 4pd or, 1,,ltial trap rr-r't�s•r t!> rl. or s:;6sf.7t 1t: a1 t rans' �r,. r - r.mraFs -: <br /> a , 15. GENERATOR'MFFEROR'SCERAFICATION:Thereby declare Nat the contentsmdtis ynsignment are tally antl aocuralety dascmbedaboaa by the grocer shipp'mg name,aN are daawlk-d.packaged. <br /> mMadend r.W1W,pMNreed,and are wall msp"erproper mnaium for Uwspal—ding lo appllradle lme—am.I.W,Aonal gwmnm Wregelarren5.lteapod9hrpmem amllam the Pmre'ry <br /> ,$' E ,bfytatew ythat lha mntems ollmscansignmenrwrdmmto thetermsoif I am <br /> attached EPAAy genedgmam(b Consent. <br /> (certify that tlla wash minur�etion statement idsnlified In 40 CFA 2fi227(a}(iFl amelargB quaMily generator)or(6)(if lamasmalt quamYy generaPo[)StNe. <br /> Genemlors Mmes Pri k6TYped Name SignaNre Month Day Year <br /> 1 l t6.Inlemalianal Sdipmenls <br /> €- ❑Irtlpoaa U.S. ❑F.aport from U.S. Portol enaylerit: <br /> = 71anspwler St pralva(fore:lpruia only{,- Data 1—.9US., <br /> w 17.TranspprkrAdnou7aagma'ItMRBOBInt ar MAterl�e <br /> oYsnsporter l Pamedltyped Name -I -! Slgnalum 4 fdmth Day Year <br /> N <br /> 4 Trapspeder2Pnnledrrypad Name Sgnalum Mm1th Da yearY <br /> a <br /> ♦ 18.zmmpanpy <br /> 1f11 1Ba.Dlwepancy lndicaPort Space ❑Reno ❑T" ❑Res sue ❑POMM Halec4an Full Releaho. <br /> Manllesl Re}erenca NNmher. <br /> 186.Ademala fac6ity(a Gene2lar) U.S.EPA 1D Numher <br /> J <br /> U <br /> �FaGeNs Phone: <br /> W Ift Sgnalure olAgemele Facidry dor Geaeralor) Monrh bay year <br /> Y <br /> w19.Hazardous Waste Report Managemenl Medlod Codes(A.CMOs for I1A2ard003 waste lMalmenl,dlaposol,and recycling syalems} <br /> O 1. 2. 3. 4. <br /> 1 20 Designaled Farillry Owner or Operator C91MG36M of recelpl of hazardous rnBler ala covered pythe msni{esiavgaplas nded n 6om <br /> yl+ prio Typed Name 188 <br /> Signature FAoa fly Yeal <br /> EPA Form 8700.22(Rev.3-OS)Previous editions are obsolete. <br /> GENERATOR'S INITIAL COPY <br /> JASON GAITAN, EHS Page 11 of 11 <br />