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3400 Auto Plaza Way. Record ID# PR0514278 <br /> 11/3/2020 Program: HW <br /> Photo 12: The following uniform hazardous waste manifest (018237414JJK) observed lacking signed copy. <br /> Fam Iowa.OMB No.2M-ae39 M �h n C ` <br /> 'Please pier!w (F—desgnedfa--- on ekla 12 Aoh) wdb+l ]Pagelel 3Emeyecy flape,aaPMre 4.ra ) uY $ , 11. <br /> Geaa«lpN �, 414 JJK <br /> Please pane tr [Fu UNIFORM MA7.ARGOU4 s 1 (RO01 A,A-9'iiYU <br /> WASTE MANIFEaT r:A 1 0 0 0 3 <br /> 1 UNIFORM FfA7.AN S.Gar,eiakla Nmrw aM Mmi MGmm C�rNa'a SM Mms+*ltl EAlnsnt Nan m.isr9 atlNesal p <br /> v+asTE MANIF� Q�p Ay pTSA 4 9E;cmi vROLET-pARGGT <br /> I <br /> r TpA�Y ci, 3400AuiO PLAZA WAr '�+ �' i Y $ ry •�' <br /> G <br /> TRA0AU1 � _ <br /> TRACY <br /> 20B A36iR00 vsEeA to Number - A,xt: A• .�, <br /> i RACY c rranaP—I r�eesry Name <br /> c ne,. Prom: WORM OIL EwRCINMENTAL URVICE9 <br /> a ranaport�1�, u s EPAIo Maros <br /> C VryORLC r Txnsaadar 2 uegany Nees C A N G 0 01 7 5 4 2 2 <br /> s r,,,,sl,enezc WORLDwIDC REOovii 4Y-ITEM INC <br /> 115.EPAIO NunbN <br /> 9(kagraled F,,dHy Nemand sna Iddre4l <br /> Yf3 MANAOFMENT INC y � <br /> s peym,apa6 Fa• 8500 US HIGHWAY 173 <br /> uS ECC YUMA AX Rr.;4fiC+ A2 ROOO 52114R �= q <br /> ` 5375S FaGa aFhone !4281344—111 <br /> LOS 0, 9D.U5-DOT O.,fien febuhigp.WRnkg Nene,Hawrd Class.lO lWnibe, le.canudnan 117,UI 12.urns 13-waste Codes <br /> raokr✓�� NM and Pack1-;Cmup(Wx,4l N. Type C—bly VA PM <br /> Hie age r I Nk N EFRA HAZARDOUS WAiTE.SOLID(PAPER Fil-WK') 5!k2 <br /> 1 r0 1 I ' <br /> K N <br /> o W z NVASH[NATSR <br /> w <br /> HASTE r <br /> arm <br /> 4. <br /> 4 <br /> 14.Spacial Handling insi—tc,s antl Addlimal In Watton <br /> la-seer EMERGENCY CONTACT CHEMTREG 1-1819300 W017S TCRMINAI'.CERES CS NAER(3R 9ft R"l"PROFILE M 981 <br /> _ EM 192R73NR r)AN00]PAPER FRYERS" •APPROPRd1TE PPE EQUIPMENT <br /> APS 15 GENERATOR'SIOFFENORS CERTIFICATION:I hereby ded-that the�tenls Orthis wnsignmanr are tully and—14y desoilbed abore bry"PmPeI SNP"MM,are ale elassTied•pakalyed. <br /> malketl end labaledplagrded,entl are in all Ia51]tt15 in proper wnddipn for Nanspon acarding t0 appswhle Inlemaarnlal and rebonal gavammanlal reguldhoni II e:q+orl shpmenl aM V am the Prtmery <br /> s <br /> 75--®r Ecponer.I-,*ural the Ppntenls of leis cOnsiAnment eonfam to the terms Wthe'r"rned EPAAckT.Wedgment01Co0SenL <br /> I cert fy that the waste mlNmi7al"statement identified in 40.CFR 262 27(a)(ll I am a large gaanary generator)Or(b)(tl I am a small quarnty generaloq is true. <br /> E, Generat iturmks RintedrTyped Name - Signature �� Nlonfh Day Year <br /> er - <br /> F 16.Intemau0nai 5nipments ❑ImponWll.S. ❑Eapad horn U.S. Pon Ol anvylaxil: - - -- <br /> .Inle Trmpcder slguture(ror exP0ds 0nlyp, Cate leanng U.S.. <br /> 17.Tran�neiACJlfr—Il of Racaipl of Materials <br /> z TmnsF w 0 noe4e MOnm Da Year Gq/g -�- <br /> c 1 Z Tra Tranepeder 1 Prinledrr Hama. Sgnatureizz <br /> Y <br /> yrrl r ' ll�y 'i^ �r <br /> Trans Nf9 Month <br /> Day Year <br /> p .i Transponel2 PnnlerYrypad Name Sgna <br /> ccCC <br /> Transl <br /> r <br /> VsorMricy <br /> pane <br /> 10.0 11 18a,Piscrepanq Indlwllon Space ❑Guartllry ❑Type ❑Residue ❑Par4al Releclwn I�FuP Relxfim <br /> T 10a.1 <br /> MBneeal Rararence Number. <br /> 1&h,AJlemale Facility(or Genarald]) U.S.EPR 19 Number <br /> J <br /> H <br /> T8—b U <br /> l4i FaGNNa Phone: <br /> q w 15c.Signature ANemale F01ily(or Generator) hbnlh bay Yeal <br /> rrr 1- <br /> Col <br /> air <br /> ,te'— , lac Z <br /> 19.Hazardous Waste Report Management Method Codes(Iit,codes for hazardouswasle veavnent,disposal,and mcoing systema) <br /> rn <br /> 19 O 1. 2. 3. A. <br /> W 1 <br /> 20,Designated Facility Gwneror Gporallor:Cerlifwtion of tecoipt of hanlydous ma"'a,""Isd by 11e...11esteKeapl ,,,Id In item 11, <br /> 20 PdritadiTyped Name SVgngNre >t1 Y Yaar <br /> L <br /> Pnl <br /> EPA Form 8790-22(Rey.3-0)Previous editions are obsolete, GENERATOR'S INITIAL COPY <br /> EPATO <br /> JASON GAITAN, REHS Page 12 of 48 <br />