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3400 Auto Plaza Way. Record ID# PR0514278 <br /> 11/3/2020 Program: HW <br /> Photo 17: The following uniform hazardous waste manifest (0 1 6870062JJK) observed lacking signed copy. <br /> .- FglnNppmred.ORB No 2956-0079 <br /> Please pool ar type.(Fore+deslgned Ierase on elite 112-PIIrh)lypawdrer) a.ypr ,Tooklrvp Nvmb.r <br /> 2.PaaerM 3Emenle"s'l Reepnme PlV�e JSK <br /> UNIFORM HAtAR0003 1.0 bill NUmaer 11 --. fl''6R U'.; <br /> WASTE MANIFEST C A 1.V U r)3 S U A;2'.5 cenereu✓s Sne Andreae Iedvae,am Wn ini emleni <br /> 5 GenenNra Nemo etl FYP pRtlEnw <br /> I r:p4.r LVHULLI Q8MINC <br /> .I4W AurV KAZh r r _ <br /> I Wily l:iw +3b1U•I _ _ <br /> eenxarpre Phay, 209 a3&-4 00 US EPAlo Number <br /> 5Transported Name <br /> ti lr+�r+lu ulL E.NYIHUNMEN fAt'3tltV1GE'3 u.s.EFAID N�mLer <br /> 1 TraneppdM 2 comr^Wme <br /> W4nn pWlut 1Te.L11YENY 9YSIEM INC US.EPA IPNumber <br /> - a Peaipreeb Fury Nem.end sae Atldea. <br /> YI1h1A YES LLL - <br /> =i E 1.1114 10 - <br /> rWOO, <br /> Feall .Perp: <br /> 19.C.orRainers 11.TOUl 12.Unit la,Waeie Godes <br /> 9a, 91 <br /> .u.5.POT P09CIrpaan tMdud'nb Propel Shryping Name,Ha+sill Ghsa.IP Number NO, <br /> Type Oednuty W1NW_ <br /> _ NM antl Pacgrq GrOuP(If enYll <br /> o MON I?L,(A NAZAxwua Wii,.%(AlU 1(Of LY SIJI IU,1Mls•tN PILrEIT,-1 SNWA7ER <br /> WASTE <br /> y � <br /> --r <br /> Speoa Nantlhrg IrebuCtors and Addilenal 11ki—tion <br /> LAIrt"01:00 CUM[AC I 6HEM IHtL- l-"LI-424-9,101 WQILb I NMI44AL LL HIL.1-a I'I'-Ir 1+.1-M:x41 ic_tr�,'•r11��r 4;A!1'J I <br /> .,.. •:r; :,plr„_I�Hi IFi!"' .Am=;>,+FnriFli Pa'p.Yg111Ph:F al r r �/ .— <br /> _ 15. GENERAiOR'SlaFFER611'11EFt,roATfON:Iherebydedare>hal the contenes ofibisrDnsignmentare Nlly and accurately descnheo abrneyme pruDBr shipp'^g name,a+�d are dasseied.packaged, - <br /> maikdand labelad`pfapNed.and a.,all respedsin propermndiban for(ani amatidlal rmrding to applicable inteand naaonal guy ooi m9uLi If e4mfl5"1" nl and i am the Pnmary <br /> _ Exporter,Icertify Nal lha wnlerlts Of this consignment_I—a Ne terms or lha attached EPAAcknovRedgment of Corsi <br /> wrtiydiet In.waste minimlzaUon stall ri Idri in 40 1262 2T(a)Idl am atarge quantity genai or(b)011 am small quanbry goner i Is hue. Yaar <br /> Gaoe Wsl{Memrs Piinladlfyped Name Signawre saonm Day <br /> J I6.Inlen ional shipnori ❑ImpodW D,s. El Dor,kdo,U,S. PpdufanvyfaxiC <br /> 1- <br /> Transpoder signalure(for ea—on O Gale Ii U,s.', <br /> w 17.TmnspoderAdnovdedgmeluot ReoNptof Malenals <br /> L2 Tlanspmler 1 PraiNdi Name. sgnalwa Mori flay Year <br /> O <br /> z Transporter 2 PnntdRyped Name Signature Moth Uay Year <br /> 'EEE SiSlGNS <br /> 'ER <br /> II+} fa-DNrlepancy <br /> I IBA,Discrepancy fndlcalfon Space ❑gvanlily ❑Type ❑Residue ❑Panlal Rejection ❑FuN Refection <br /> Ir Mari Relelenre Number. <br /> - 186.Ntemate Facility(or Generator) N.S.EPAID Numtrer <br /> J <br /> U <br /> LE Faall7e Phone: —�- <br /> LQiI I&Signature ofAllemale Facrbly(or Generator) Month clay Yeal '` <br /> a <br /> Z <br /> N19.Hazardous Waste Report Managerni Mauled Codes(i.e.codes lorhazardou9 waste treatment,disposal,and IaryGlnp systems) <br /> a 1, 2. 7. 4. <br /> 20.PeagnalEd Fanbly OAner arOperator Cerbrication of recelpl olhazardous matenats wyered by me manifesl except as riled in Item 10a <br /> PrrnleVypsd Name SBnalure Month Day Year <br /> EPA Form 6700.22(Rev.M5)Previous editions are obsolele. GENERATOR'S 1NMAL COPY <br /> JASON GAITAN, REHS Page 17 of 48 <br />