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3460 Naglee Rd. Record ID# PR0517826 <br /> 12/7/2020 Program: HW <br /> Photo 15: The following uniform hazardous waste manifest (016769287JJK) lacking signed designated facility copy. <br /> a54,,.ya.•+°';w"" Please p-1ar pa.(Fon designed ror use on elite(12-pilch)typewriter.) Farm ADpwvetl.OMB No.2056a039 <br /> 1= UNIFORM HAZARo0u5 I-Generakrlp Number1676 7.Pagelol 3.(icer9eiwy Response Plwne I,Manllesl Truhln9 Num�r jdK <br /> D WASTE MANIFEST CAD026477088 1 �90Q)424'OSlL1� <br /> '"`ra'"�� 1 ,aanaramnsila Adams 4l dllerefllban mooing adaessl Il, <br /> s.G'Vbh&W&QWAEWAL <br /> F OOAIPTOk SAWA FE AVE CA 9= fr <br /> Generalofs Phene' 3�0OO <br /> 1j5_ AION mbar <br /> E.trona rl company N�IMRO'Mru CAD�12 Jl2T70E6 <br /> OERVICIM <br /> HS.EPA In raunber <br /> � t.Transporter2 Canpany Nama <br /> �� ���d��� 11.5.EPA I9 Number <br /> e.Oes nalry etl FaaliIENYIIR71'I11!VaAL <br /> =0111"RD CA 95W CAL000303440 <br /> F-1,-'s Phone: (70@)841-1A25 <br /> Us.oOT Besmplion pndueing Proper Slipping Name,Hv"Claes,10 Number, N.Containers Qu Total 72 uMl 13.Waste Codes <br /> 9b. <br /> HM and Packing Groupnd,41 Na. TYPO uarmty WLNo1. <br /> 1 NON4NM kAMDOUS WASTE,uQuH) OIL/mrAED 00.) 721 <br /> o 001 TT <br /> z <br /> ill <br /> ED <br /> 4 <br /> 14 speoial Handling Into Hons and Additional lnfonnalion <br /> aooEWAMWYD00*W':0= r�a raa Ti �c <br /> r at <br /> 15. GENDiATOR'Sl9FFEROR'S CERlIFiCATfON:Ihmehydedarertal the d.-i ii.—gnment are fly and a=ralely deacnaed above by rhe Pyr 5hPPr+9 name.and are dasslaed,pac'eaged, <br /> - marked arra labeledlplacarded,andIn all reapeW m prayer=&U.n fa napspoAaffording Wappkmblu lnlematlonal and na"govemnre-regulations.11 eapnR shipmeal and1ern the Primary <br /> Eapater:lceniy>haldsa wnlenLa o[lhis cana7grvrienl tpnfoanWthe tomo of the attached EPAAckntlraedgmentel enL <br /> - Icerafythat dl este minimiralien s7afem aced in4d CFR 262.27(a(lillama large quanliygeneratnrlm{b)( amasmanquantirygeneralorlisAue- yyye�eayyr�I <br /> Generam rinl,1,7yped Nam \ Signature Monll>< C]�'y� <br /> J 16.Intemabonal Shipment$ ❑Impcaf to U.S. ❑Prpurt lmm U.S. Port of enbyletil: - <br /> Transponer signature imreaports only}: Dale laahngUS <br /> ]7.Trans porterAckn edgment or Receipt ofhlatchals q�¢y+ yry�a(1� <br /> w Monuy_, L l 4 <br /> Trees d YPN e •� 1A Sign re [� <br /> z Transpo er PnnledRyped Name Signature Monty Day Year -- <br /> 4 <br /> t- <br /> 18,Olscrepancy <br /> f8a.Rismepanry ladicaflon Spa w ❑{]danGty ❑Type ❑Residue ❑Partial Relecdan ❑Full Releclion <br /> Manifesl Reference Number. <br /> ISb.ARernble Faukty{or Generalor} U.S.EPA ID Number <br /> J_ <br /> LL FHPiIlyre PllOno' - <br /> w 18c.5ignahlrenFPllemato Facility for Generel0rl Month Day Yea[' <br /> a <br /> w19,Hazardous Waste Report Managamant Melhad Codes{Le,codes Mr hazardouswasla troalment,disposal,and mcycling syslems) <br /> 4 1. 2. <br /> 20.Reslgnated Facility Oameror Dperslar CerUflcatlon dl fecelpl of hazardous maledels covered 6y the meniksi Bacept asncted m Item 18a <br /> Pnntedflym Name Signature Month Day Year <br /> EPA Form 87OC-22(Rev.3.05)Previous edillonsare obsolete, GENERATOR'S INITIAL COPY — <br /> JASON GAITAN, REHS Page 15 of 21 <br />