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795 E Roth Rd, French Camp Record ID PR0546244 <br /> 10/15/2020 HW Inspection <br /> Photo 4: Facility did not have a TSDF signed copy of uniform manifest 006239883GBF. Facility also did not file an exception report. <br /> please print or LYpe. Form Appa+rsd,OMB r,1o.2050 Cg39 <br /> UNIFORM HAZARDOUS 5-Generslarli` 12.Pap t of 3,Emergence Response P ne.>NanN"tT"`xlnv N°^b'r 3 GgF <br /> WASTE MANIFEST 3`.�'p0 <br /> tw 5,G—raters Name and MailingAddmss Genemfofs Sim Address(dtlirtererrt Umn FneJrl address] <br /> 45 SMART TECH DIESEL FILVAIR <br /> N6 E ROTH RD <br /> .y:. Gerieramrs Phon- HREr1CH CAMP,CA 110�i u.S.EPAIDen,mber <br /> 6Transpdter 1 Ch n <br /> u.5.EPAID Nember <br /> 1 Tanspoder2 Company Name APAERIGANIMALLI-Y WASTE OIL 1W <br /> RildfllS.EPAID Namber <br /> B-Designaletl Feclldy Name aM SIIeAtldress AZIRDBDSTditd <br /> YLIMA yes VMS I IE TRANSFER FACILITY <br /> 0600 US MX(dFWAY 85 <br /> '&W,AZ 06306 <br /> F-IhI sPhage- ta.co.,Ialnem 15.Tdra1 12.unst 1,.wase codes <br /> a,llS.DOT Descnpri-C-ilding Proper ShipPng Nama,H—d Clam,ID Nemhar, No Type ci.mrft WLI'Vel <br /> ._��_•.• HM antlNkhg r—P la"'Y)) <br /> `4PYq,�,� pAl'ER�71t I 'ISOP <br /> o <br /> hk-A,&Rr.RA*rArpf?U[NI.SWA4►ERo±10.A88ORtSE1'R6. <br /> FII TFRS i rYEBR18 <br /> _ W <br /> G' n. <br /> P <br /> V <br /> —1-4S,mal Handriag Inahucdone and Additional Informeaon <br /> MOFIC60 fR4pLR REFERS ERCa'.CI i7'I <br /> EUERGENCY C,`ON1FACIr:ANIM name,and are rlassiLed,packaSed• <br /> dtetl and laheledlPla 2rded,end ere in all respecm In proper condition for ...pod acrrirding to a pPliCahalnt.,,sWaiendnsaorrelgrnemmerdal regulations-ilamort sMgrentandlemthe Primary <br /> 15: GENERATOR'SVOFFERflR'S CERTIFtCATIDN:Ihereb/tledare giat the coolants dfNls Ppnslgmnent Bre iulN and accuramN described above M'rhe Proper p1 <br /> that the wntenls of this cunei nrhenl "in, to metemrs of the aaachetl FPAAcImoWradAment of ConsenC <br /> v ErpoNer,[cerlify 0 e mr orb dlamasmau quanliry generatarl Rtrue. �,m Day Year <br /> IceNfy h2lth—aslemimmlxaEian smtementitlenii�dIn 411 CFR 262.27{a)4d areaVarga quaMLygg�aue 41l O ` <br /> Ctrs ramr'sl0lfemrs Pd t dlTPAed Name /l 1 <br /> Shipments fnlemadonal IJ Export ham US. <br /> i6. Part enhyfeuL�� <br /> ❑Import to U.O. Date ieauing U.S': <br /> i Transporter signature{for e.ports only): <br /> menlofReceipt of Materials Mgmh gay Yaar <br /> K 17.TranspwterAcknovAedg sign _ <br /> Transpoiler yped area <br /> m1ii"A 1 e <br /> a Signa we <br /> 4?4 Tran o r2 yped Nama <br /> F <br /> rO.Disaspancy ❑Parhal Re]ection ❑Rdi Rel�an <br /> 1Sa,Drs=ancy Indioatlon Space OdaMity <br /> ❑type ❑Residue <br /> Manifest Relerense wi mri. <br /> U.S.EPA 1D NamLer <br /> 1$L Altemate Facilry(or Generator) <br /> 1 <br /> V Monlh Day Year <br /> r4i Facilityrs Phone: <br /> C3 18c Signature nFAltemate Facility(or Generator) <br /> Q <br /> z <br /> ti19,Hazardous Wails Repod hlenagemenl Method Codes i.e..cutler for haaardouswasle Seatmenl,disp3 al,and recyUing systems Notice-State Of CallfOrRla reC;U5r05 <br /> hotocoQY <br /> and mail to <br /> as generator tO p <br /> 20.Designated Faplity owner or Qperator Cewfcation drecalpt of hazattlous materials covered by the Slgnature�p4 need in Item 18a DSSC with 30 a8ys' <br /> Ph".,Yped Name p,Q$OX 400 _o <br /> ' a <br /> s5a1 "4annlALtiOPY <br /> EPA Form 870-22(Rev,12-17)Previous editlops are obsolete. <br /> Sacramento, <br /> John Alaniz, REHS Page 4 of 10 <br />