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3400 Auto Plaza Way. Record ID# PR0514278 <br /> 11/3/2020 Program: HW <br /> Photo 13: The following uniform hazardous waste manifest(017696549JJK) observed lacking signed copy. <br /> F10ae, noteal -r-4-inanxe for uae ID x111,12 Itch) 'ler.i - � - Fonn Apemvatl ObAB No 2GSa 00]9 <br /> UNIFORM NAZARPOOS 1 Gme,amr ID <br /> Nember 2.PagelW a.Sm,gercr Rawame Pbaw — <br /> IypSTE MANIFEST L A L O O U 3 3 0 4 2 3 1 lePOy 4249300 (}17 8 6 5 4 9 ,43 fC i <br /> S.D,neraMrll Name W Malmg Atld,au 6emra4ofa SilalWd�a ld tltll,rtM man maeay Ndtta! �l� - <br /> TRA.CY CHEVF7CILt T l7 3r r4 INC <br /> 3400 AUTO PUVA WAY CA 9304 <br /> TRACY <br /> '-09835.4 500 <br /> U 5.EFAIDNu <br /> 6.rnon rl,warranW,) 1 Lam N,m, c A G 0 2 L 8 1'7 U y <br /> WJRLO CAL <br /> iL ENVIRr7NM EN IAL SERVICES <br /> U 5.EPA m Number <br /> 1.T2mpa•t,r]c,,,,pany Name <br /> U 5.E➢A19 Number <br /> a.eesynaled Faalny Name aM 54W Atldmss <br /> US ECOLOGYVERNON INC <br /> 5375 SOUTH BOYLE AVEl' CAD 0 9 7 0 3 0 9 9 3 <br /> LOS ANGELES CA 90058 <br /> red, .Pyne 323 27 7-1500 <br /> 9b.US-DOT DeacnpbdlilrtludM Rm'SNppaq Name,lClaw.ID Number 10.Geriatrists 11_TWAl 12.11nd 19.Wazb Godes <br /> kM end PeN+xg GrxePalenyli Na. Type OVaoalY W114d. �- - <br /> rNOl HAZARDOUS WASTE,SOLID(BRAKE LATHE SHAVINGS) 01� <br /> = z <br /> ��~ 7P/WASh'WATER <br /> a. <br /> WASTP <br /> ---�ti� :d.special Aandimry lnswction%and hddloonal lnNrmatl"n " <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CEDES CS NAERGx 981:17i*PROFILE N 9B1'- <br /> tlow AP190186 BRAKE LATHE SHAVINGS*P5()0-00056720*APPROPRIATE PERSONAL PROTE TVE EQU}�MENT/x — - <br /> � W name,a�ane dassifled.pa�aged, <br /> -� 15. GENERATOR'SIOFFFROR'S CERTIFICATION:I hereby declare that the contents of Ods Ula Primary <br /> marked and lahmnvgnmenl are iueyaid amaa4ely 1lrsalbad above the Pmper sh+PPn9 1 d I am - - <br /> dWwrdea. .remedrpaid aE reapaCs inP�rmndNon for llansPM acwrdilg to appllwtleinlematnnalalM national 9ovemmenral+e9uVaEau-HewoR stllpmen an <br /> Fxpoder.Iceru oy llhemntenl$of Uusmnsi9nmerl mnlmm to thetem.e 0 the attached EPAAcknoe W9-or fCensanl. 14uanti a Vs We. <br /> I reRlry umi the xasw mini ll swl nen idenfified in a0 CFR 26227(.1(il I am a large quan ty g Month <br /> Sl nae re <br /> e sfOfle YPe� <br /> .Intern il shipments ❑ImpoA la U.S. ❑Expert U.S. ofrntrYle tt. <br /> F Date laavtng U.S <br /> Transporter signature(for e4wrts cnlY)' <br /> W 17.TransponerAckno'Medll�l ofRem10 Malarial. Mold, Oay Year _ <br /> �Tran 1 Prints 1Nr Na <br /> a= 3 Monty Oay Year <br /> z Transportao 2 PnntedrYYPad ams Signature <br /> r - <br /> _ 1B.Oisuepancy <br /> 18a.Discrepancy IMicaiion Space � ❑Type ❑0.esidue ❑Partial Roloc06n ❑Full Rejection <br /> r � Ouanoty <br /> � Manllesl Relemdoa Number: <br /> U.S.EPAI9 Number <br /> 18b.Ahemale Facility(or Geaamtor) <br /> J <br /> w Facil WS Ptrone: MmUt Day Veer <br /> i8c-Signature ai Atternala Faulay lw Generator] <br /> S 1 <br /> z <br /> 19.NazGrdoes Waste Report Management Method Codes Ii.D.,rectos ferha2artleus waSW IleaUnenL disposal,and recYd'vr9lyslams A. <br /> LU <br /> 20,Designated Facility Owner or Operalor.CoNflaGonal receipt of Hazardous mailwvered by Um mariliesleacept as need in Item 18a Month Day 1'eai <br /> Fnoled1Typed Name Signature <br /> EPA Farm 8700.22(Rev 3-05)Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REWIRED) <br /> JASON GAITAN, REHS Page 13 of 48 <br />