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3460 Naglee Rd. Record ID# PR0517826 <br /> 12/7/2020 Program: HW <br /> Photo 21: The following uniform hazardous waste manifest (020382257JJK) lacking signed designated facility copy. <br /> 14 - Form Approved,OMR No.2050-0039 <br /> ease pNntwTyPB, r-Nenlfeet Tmcldng NPmber <br /> UNIFORM HAZARDOUS I.Go...lu Numbtt z.Page I of 3. (Si <br /> F0 2 0�82257 1 1�( <br /> WASTE MANIFEST CAL000455401 1 8001424-9300 �J aJf` <br /> General0ts SIIBAsldmss(II dreemM1l Nan malling address) <br /> 5G TWVC 3GEJEEP RAM <br /> i 3460 NAGLEE RD G 95304 <br /> y }} TRACY <br /> 7�f Generali Phone. 209 820-1600 11.5.EPA 19 Namher <br /> s.TrariaWORILD�]IL VSVL ENNameVIRONMENTYhL SERVICES CAD028277036 - <br /> U.S.EPA 10 Nwnher ' <br /> r Transposer 2 Camny Name CAR000175422 <br /> WORLDDE RECOVERY SYSTEM 1140. <br /> 11.5,EPp10 Number <br /> 8.Dealgn0led Farnlry Name end Site 0.ddre55 <br /> YES MANAGEMENT,INC. <br /> YUMA <br /> 65WUSHIGHWAY 95 85368 AZR000521146 <br /> Faula Phone: 926 9828 ' <br /> S US.GOT De—ra - iA, Pr rShi Name.Hazard Class.in Number. 10 CAnlainels U-1a1 12.Una 53.Wast.Cedes <br /> 9a P'on(Irc 9 ©a Shipping No rYPe Ouanlily WL Not <br /> HM ass Packlrg Gap(il any}) <br /> 1 NON-RCRA HAZARDOUS WASTE.SOLID(OILY SOLIDS) 352 <br /> o C! DM I'S P <br /> z 2 <br /> 0 <br /> • 3 <br /> • 4. <br /> • 14.Special Handling InaWeaans and Additional Irde+malion <br /> Vert.Y 981 <br /> .TJ�ryfi EMERGENCY CONTACT:GHEMTREC 1-601}4245300 WOES TERMINAL CERE3 CS NAERGM 911:III'PROFi <br /> . TRA691-162623NRS OILY SOLIDS° "APPROPRIATE PPE EQUIPMENT SS <br /> 15 GENERATOR'SfOFFEROWS CERTIFICATION:I hereby dedma that the I Ioats ofthls consignment are luny and awuraleiy tlesrnbetl ahova by the plaper shipping name ab are daulhed.packaged_ <br /> marked and W611dlptararded,and are In an respects in proper wndltlon for transp.d according to applicable intemaliansland nabbnal governmental re9110o11s,ll eepnrtshlprrlent and I am Ne Primary <br /> . uposcr,I unify that the oonleals of this consignment conform to the terms of the ahached EFAAcknawtedgmentof Consent <br /> 1 wdiry that the waste mrnimiza0on statement identified In 40 CFR 26227(a)fit l ama VatAe quantity generator}or Ib)pl ama small quantity generaioq rs we. <br /> Siglure Mddh Oa Year <br /> GeneralohlO®erofs PnnleNfYped Name )/ <br /> J 16.IPtemabonal Shipm.nt6 ❑Import to US. ❑Export from HS_ Pon Pl enl"i-t'. —' <br /> "r Date leaving U.5 <br /> r Transporter signature(for exports gnlYY� <br /> s 17 Transporter Acknewledgmenlof Re iptof Mateimt <br /> • near <br /> Tran iter t P11npytedfTyped Name <br /> �P YL,bb o (l7f1 <br /> Month gay Yea, <br /> aia Transporter 2 Prinledffyped Name SignaNre <br /> K <br /> I* 18.Disc ap <br /> . I 18a,9isuepancylydiwbon Sparc 0.ani Type ❑Residue ❑Pamal Relecaon ❑FuH Reiechen <br /> MareW Reference Number <br /> iBo.Atlemale FadGry lar Generator) U.S.EPA 10 4=1>er <br /> . J <br /> U <br /> ua. FaciliNs Phone: <br /> w 16c.7gnatars ofAllemate Fadliry)er Generator) Month Day Year <br /> d <br /> u�U1 z <br /> 19.Hazardous Waste Report Management Mai Codes(i.e..codes for hazardous waste Ueatment,disposal,and recycling syslams) <br /> w I 2 3 5 <br /> yL 0 p <br /> b• I 20,Ces'Ignated FacililY 0.ercr Operator CerG6rafion of receipt of hazardous materials covered by the manifest except as Med in Iona 16a <br /> Signat <br /> 1 PrintedlYYp�Name ure Monty Day Year <br /> • EPA Form 8700-22(Rev.12-17)Previcus editions are ohsale(e. GENERATi INITIAL COPY - <br /> JASON GAITAN, REHS Page 21 of 21 <br />