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3400 Auto Plaza Way. Record ID# PR0514278 <br /> 11/3/2020 Program: HW <br /> Photo 15: The following uniform hazardous waste manifest (017467670JJK) observed lacking signed copy. <br /> r <br /> Form Approved.UMB No.2050.Co39 e . <br /> Please pool or type,(Farm tlesigned for use on elite 1Z-ptch)typewnler} �.M f ilaatimcMmg Hamner �� ti <br /> 1 Generales lu Number - 2.Pape 1 d 3.Emer9en Y Response Plwne _ C77 <br /> r7­�, <br /> M HAZARDOUS 6--+ <br /> E MANIFEST •++, -'rent than meiTWAu4 V PLA•:A riAI95�P4 <br /> �� y r rPbane: 11 I C.mi Nw a ifil U Uli t r4,4IhY/NMIFiTAL SEFMGEy 1+ <br /> 7 Tmnsp r2 Company Name u.S.EPAID Numhr <br /> S.EPA 19 Number <br /> S Oeslgneledf-1 Name erb Site A I*ess 11. <br /> UtMtriwI KtRUUUN <br /> �W. Q N.ALwAl 5711 <br /> uiiv K64i CA <br /> fad, sPhane• <br /> ga goU.S.Dar Cesoiptionenaua J Proper Srippig Name,iClose,In Number, to.Containers 11,Trial 12.Un11 53,Waale{'odes <br /> HM antl Packing GmaP(¢anV)I <br /> Nc Type Q—Uy "i <br /> � o 'wv1�5,+.wAsd t r=1AMfW4NLt uqulo 14�� ,1.A;,uuNr Ulb:ieL <br /> co <br /> 4 SUMP/[•yASN(ryAT�-i <br /> WASTE <br /> 14.Spedal HandLrglmt on;endkdibonellnlamation <br /> EMERf)ENCr CGNIAi'CN£A4TREG 3,440"24-93W3,440"24-93W WUE9 TER10114ipL'.' iES CS NACW�*UW-Loth"r!e(IrIIL Y tie T NT <br /> 4_ti;i50GA-y{ll.GIkBEL" •AFPFrcWRV+F£P£RSUIVAL4'Rt1IF.CIiYt kQl11F'Mtr[i _,_ <br /> 15. GENERATUR'SfUFFERUN'3 CERTIFICATIGN:Ihemby declare that Ne eoments of Nls rnnvgnmonl are tulyand arnrmtcNy desenhetl ahoveby the pmpar shippag name.snot are tlassified.packaged. <br /> marked and labrar <br /> eliiNpladed,arM aurin all respells In proper modiliionforinanspod acwrding to applicable inlemeMnalard nallonal goNemmentel+e9ulaBwvs.Nexport ehigmenl and I am She Primary <br /> Exporter,I carat,alar the mntenls oforis pmnsignmenl contorr totlm termsdthe alli EPAAckouMedgmeotof Consent. <br /> t cert4y Nal the waste minimkaticn statement Idenefied'm 40 CFR 202 271 lilt am a large quantity generator)or(hl lift am a small quantity generstoryis true <br /> �' GeneretoysrORerofs NnI.LVTV ed Name Signature Monln Pay Year <br /> 16`ematicna15hipmenls Chili.S ❑P+pon4omU.5 Porldemryrexirt. <br /> z Transporter signature hmexports only} Pate tearing U.S,: <br /> 177ransporterArklrm+redgmenl dRecaipl of Malaria's <br /> Month Day Yeal - <br /> Tmmpcmer 1 Pnnledl7yped Name SgnalVre - <br /> 0 <br /> 4 Tansponer 2 Pnnledli ame Signature Month gay Year <br /> a <br /> 18.Discrepancy <br /> 18a.Discrepancy Induration Space ❑puantiry ❑Typa ❑Residue ❑Partial Relecbon ❑Fus RelecGan <br /> Mini Reference Number: <br /> 1 Job.Alternate Facility(or Generators US-EPA ID Number ~----- - _.- <br /> U <br /> LL Facilii Phone: <br /> w 18c.5igni olAltema'e Facility for Generaloi) Month Day Year - NS <br /> Z <br /> LU19.Hazardous Waste Report Management Method Cotles(Le„Codes for h4uerclous waste treatment,disposal.and racydingsyslems) <br /> g o 7 <br /> 20.Designated Facility Ownerur Operator Cerbill of mceipl of hazardous materials Covered by the manifest except as noted in Item 183 <br /> Pridrdriypad Name sgnature AIonN Dap Year <br /> FPA Form 8700,22(Rev M5}Previousedl6onsare obsolete. GENERATOR'S INITIAL COPY <br /> JASON GAITAN, REHS Page 15 of 48 <br />