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3400 Auto Plaza Way. Record ID# PR0514278 <br /> 11/3/2020 Program: HW <br /> Photo 16: The following uniform copy.s <br /> waste hazardous manifest (017696223JJK) observed lacking signed <br /> -- R - - - -'- _ 1 <br /> Please pant or type.(Farm designed for use on elite(12-pitch}ypewriter.) Farm 0.ppmved.OMR No 2050-0639 <br /> UNIFORM HAZARDOUS GenenNr IO Number 2.Page 1 of 3.Emergency Response Phone d.Manpest Tnckl KumnCvr']�]'] 1 <br /> _ __ WASTE MANIFEST C A t 0 r>U',3 G A^'l I 16001 4249300 Lj G G J y�K <br /> S.Gen Iota Namg epi Matll�gptltlrese GenemWle SlleMtlmae(ddAlemnt Nan maAing adtlress} 1 <br /> 1 RACY f:MC4RU{,�t Qs1 M!NC <br /> TTrIAAC, <br /> 3400 Al PLVA WAY <br /> Generarafs Plane '?US <br /> 6 Tmnsponerl Cmnpeny Name U.S.EPAIO Number <br /> wilHl.[a OIL ENVIRONMENTAI.SrMAIS CAD <br /> 028 <br /> 2 7 7 0 3 6 <br /> 7 Tmnslxxter2 Cerra Nems U.S.EPAIDNumaar — <br /> WOHTD1L�'ICTyIRtcoi51'3fEMING CAR0001754 2 <br /> B Des' clad LIMA Y Fop Name sntl SiteAtldresl U.S.EPA IG Number <br /> 2330 E 13TH ST — <br /> YUMA AZ A53n5 A7RO0051 B924 _ _ _ <br /> P <br /> aulia. IRIS <br /> .DOT NvApbon(ndutlinA Pmw Shipping Name,Hants Clan,ID Number. 16.Candinem 11 Total 12-Until 13-yyasle Codes <br /> tYJnA Group lNanylNo. Type ouanhy YAW. <br /> PCRA HAZARfn7U5WASTE.SOi1D 1 OILY SOLID PAPTR FILTEll 352 <br /> 'WASNLI/ATERHAST€dling Ins W teorte arts Additional InrmmahptENGY CONTACT.GHEMIREG 1-POG4249,100 WOES TERMINAL:GCRES 4Ya "PP.l7FILEil 3F51-162623NTtSQAN001 <br /> PAPER FIL'I' "APPROPRIATE PP£EQUIPMENT <br /> 15 GENERATOR'SlCFFEROR'S CERTIFICATION,I hereby declare that the cantents oflhis o—ignment are fully and accurately d—ribed ato—by the pope,shiwng name,andared"aned-packaged. _ <br /> _�_� marked and labeletllplawrtled.antl are in aft respecu N proper eondreen Nr 4ansport acrnrtling N applir„ble infemailonal and naaaal govemmenlal regulaaons.tr capon shipment and I am In.Primary — <br /> Eoner•I spneray Nt th <br /> ae ooMen6 of tris osnsignmont conform to the terms of em allached EPAAcknowledgment of Consent <br /> -rw Iavtry Nal Ne-,I,mrnlm:erloi statemen,1den11edin 96 GFR 262.27(a)(if l am a large quantity generator)or{b)(if l am a small quantiy generttor)is true. <br /> Gene2l01slOfferors Prinledrfyped Name sanai Month Day Vaar �Y <br /> $ 1 16.Intemar,artal Shrpmenls <br /> ❑Imponm U.R. ❑E>maRfrom U.S. Pprtorentrylexit. <br /> Transporter signatum Dor eapohs only) Date tearing U.S.: <br /> w 17,T,anspaterAcknovAedgmenl of Rererpl of Materials _ <br /> ~ <br /> E2 Trans rte,3 Printed?yped Name g <br /> K pa gnalutB Mmlh Day Year <br /> N <br /> Transpodar 2 PanlaNfyPetl Name Signature Month pay Year <br /> -_ 18,Uiscrepanq T <br /> Dismal Indirafiwn Space ❑Ouari ❑Typy ❑Residua ❑Pasnal Rejepron ❑FulV Re,aodon R� <br /> If I Mandest Ralerenee Numbe,. <br /> 1- 1111Altercate Faadty(or Generaloq U.S.EPA ID Number <br /> J <br /> U <br /> UFacihlyvs Phone: <br /> Me Sgnalure olAltemala Fanlry(or GenerataQ <br /> F- Month Day 1aar <br /> 4 <br /> 2 <br /> N19.H2erdas aWaste Report Menagerrenl Method Codes Ii e.Dudes for hazardous waMe traaldnonl,dlaposal,and rai systems) <br /> a 1 2. 3 4. <br /> 20.Designated Facility Owner or Operator Certifirapon of wopl at hazardous materiels covered by the on itesf oti as noted m hem 18a <br /> _ Printedlfyped Name Slgnelwe Month pay Yaar <br /> EPA Form 8700-22(Rev.3-05)Previpusedi0ona are obsolete. GENERATOR'S INITIAL COPY ` <br /> JASON GAITAN, REHS Page 16 of 48 <br />