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3400 Auto Plaza Way. Record ID# PR0514278 <br /> 11/3/2020 Program: HW <br /> Photo 24: The following uniform hazardous waste manifest (0174686610JJK) observed lacking signed copy. <br /> F01111 Ap"vad,OMB Nu.2050-M38 <br /> Piease pdnt or type.)Font designed for use an elite(12-pitch)lypewNler) 2 page a of 3.Emergency Response Phone 4.Manlfeel T7ld Number <br /> UNIFORM HAZARDOUS 1.D,.wr lD Number f1� �C` JJK <br /> WASTE MANIFEST C 1111011 3 3 U 4 2 3 iJJ <br /> 5 Generators Name and MalhngAddmea Generators Sat Add—(if ddferent than maiing address] <br /> I FWOY[:HLVF:(dLEI V A M INC <br /> •400AU10PWA WAY_ 1RAGY <br /> Genemara Phma: ��'08 A.55-4500u.8 EPRID Namb¢r r <br /> 6.TmrnpdVar 1 C mny Nam. <br /> WUHi.0()II.LNVIHONMtNTA..EHVSL'E:7 <br /> -- _ 115 EPA ID Numhel <br /> i T.,,p t r2 Company Nama <br /> us EPA IDN-W, <br /> B oeSgnaled Faalla Name and Sile Address <br /> 1-5 LIAXIjUf VLNN4}N 11 IL �L <br /> ',315 SOUTH l30YLE AVENUE 1�rs <br /> �i OG Al CA 4705N <br /> Fao11 sPMna: :� ti- <br /> ID.Containers a Total 12.unit <br /> 9a. 9h U,S,DOT Desaipban(nd Wbq Proper Sl.ppirg Name,Haaard Class,ID Nmnber, <br /> and13.Wesle Codas <br /> HM P doll,G-P{eanyll No. Tape Qpanbty WWek. <br /> y-irORA HAZARDOUS WASTE.301-113(bRA14E LATHE SHAvI+ - <br /> o _ <br /> z 2 ITER <br /> � I <br /> RlNLV�R 3 <br /> T�s-al Handling I7l77M..a and Addillonal Ihlu-11O1 <br /> r4LRUN6y WNiALf (.HtNtlkkl: :r,v r4�•:-:;:•,'.,t;rant'.•u t:n:i�: 1:..:_.. .c.: k �... •.a.: ._...._., �� .. <br /> a� �;;A!lE LATHE SHATill aP50GJ30664M2*APPNOPMATE PPE EQUII•MkNf <br /> 15 GENERATORVOFFEROWS CERTIFICATION:Ihemby deck--that to oontenb5 orins mnslgnmenl are fully and Y—mtely mismbed shore W the pr000r Shipping name.std are dt—Olk,packaged, - <br /> __ marked and Iabelenlplararded,and are In 0—pe IS in propel¢ondelon for tranwri 9—ding Y,apphraba iniematiunaland national gorammental mgalabons.If expert SN—M and 1 am the Pn—rf <br /> Esp¢ner,beth ural the-mems of This WMignment mnia to(ha terms of dre attsehad EPAAcknodadgment of Consent <br /> wrldy tat tea a aasle minimization atalemeni rdenAW 1n 40 CFR 262.27(a)til I am a large 4uanbty qff a tor)or(b)(gl am a s Tifg Quantity generator)a we -- —— <br /> Gexmlors+olamrsPnnadlTypedAl— Signature Merth Day Year <br /> _- 16.Ine-Wna15hipmena � <br /> ❑ImpeG to U.S. &K"Orn port olemryleatl: <br /> TnnspoRer ygnal-ILor aspgrt.only) Dole losing U.S., <br /> _ w 11 Tmnapaher Arknftmdgmenl d Ri-uji d MaM45 <br /> SPIE TransN-1 Pnn*ffyped Name I $IgrtrRaa xlona DAY Year <br /> C Transporter 2 Pn.l Iype Name 5ignalme <br /> Month DeY Y.ar <br /> -- off <br /> F- <br /> ra D�6rrr:panry �^"" <br /> 1aa D15uepancy IAd.W.$pada ❑Ouanbly ❑Type ❑R@.Wee ❑Parcel Relechon <br /> ❑FuN Retacbon <br /> Manifest Re%.—Nbmbi r. <br /> Ibb.Allemale Famldy(or Gmmratm) US.EPA ID Number <br /> _ I�r_ FaGlilyS Phone' <br /> --- w rff.5gnalwe of Allemeld F.Illty lm Ge-ab.) ysonm Day Year <br /> r <br /> Z <br /> h19,HaaardWa Waste Report Management Method Cpdea(1 e.codes ha hamrdgue wean trealmpnt,dtepomi,and recycling spl—) <br /> Cf, <br /> 1 <br /> rag.De5lgnaled FAelrty DWnar IX Dpara.,Ceti4ration al mut pl OT hazmdaui mBlerielb mvaad hY IFN maM1IIA61 oktrepi A4 n6ed In Item 1 fa <br /> Pnnted?yppd Name Sgnahae 6bndl DA, Yaar <br /> EPA F.Tn8700-22(Rev.3-05)Prealaus ediLans are obsolete. GENERATOR'S INITIAL COPY <br /> JASON GAITAN, REHS Page 24 of 48 <br />