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Please print or type.(Form degigned for use on elite(12-old1)typewriter.) <br /> Form Approved,OMB No.2050.0039 <br /> uNFoAHA7.ARDcqjs I I.,Gemmtor ID Number al asit <br /> WASTE MANIFEST <br /> al61101 -1611M 71 ber VES <br /> SGereraWstuarnand MaMngAdrimis Genera Ws M Address(d differend Ow mining 0dress) <br /> PACTINT PACY�&.GING.Uf P&MV PACKAGING IIIc. <br /> 45&3.AqTAS UNE. 110 PERINDINCE DFAIR <br /> STO MDR,CA 9326– <br /> STCICKTQN-CA 95206 <br /> GenerataesPhorw,-.20 491-60i,l <br /> 6.Transporter 1 Company Name US UAIP NM*U <br /> VEOLjA IS TECHNICAL SOLUTIONS 6 <br /> 7.Mr2 US.EIRAIDNinnber <br /> ICA <br /> 8.Dasig.Wd Facilill,Nam and Site Add U.S.EPAIDNw1w <br /> m"WOLLA�'ES TECHNICAL SOLUTIONS- <br /> L.L.C. <br /> OLUTIONaL L,C. <br /> 1704 W.MUST STREET <br /> — AZUSK CA 91702 <br /> Facilil's Phone: i 26 ?34.511 <br /> A '15a � 23t, `190 <br /> gh.U.S.DOT Dascrip6m,(macludill Proper SNpping Name,Ma 1O.Cowas rs 1I.Tdal 12.Unit <br /> Us. zindClass.11311umlew. 13.VWe Codes <br /> T— -1 <br /> HM and Packing Group(it any)) No. Typeom* WLAU <br /> N014-RCRA HA7AADOUS WASTE LIQUID,!USED MOTOR <br /> OIL.) <br /> D 114 9 G 0 P <br /> 2. k,3N-RCA_A HAZII,�pDoUq WASTE LIQUID.j.MK 491 <br /> WATER-BASED) <br /> 549E <br /> & NON-RCRA HA7"OUS WA'TE SOLID,k.fNK SOLIDS) 351 <br /> I C. M 3354 P <br /> 4. <br /> 14.Special HandfinginstructonsandAdditional Information + 1)W177214 A AZUXUEUa7 2)7.1 096f A REC- <br /> SwR qelviu C,,Ct�-,,twrl VESTS <br /> WATERaMMA) .)W100f9A:AZU-DEWJRLeN'S <br /> 15. GENERATOR'SlOFFEROR'S CERTIFICATION:I hereby declare that the contents of lhac igvnem we fullyand a=xately dambed athave by the propr slipping name,ard am dasarwrl,packaged, <br /> marked and labetedflacarded,anal are In d mspedsln paper=dllion for transport according to applicable IntemMlowleM nal governmental regulators.If export shigmenI and I am the Primary <br /> Exporter,I oe*that the contents of bus mrsignmenl conform to the terms of the attached EPAAcknoyledgmera of Comara. <br /> I carlifolhal the vrasle minimization shaternart identified in4D GFR 262.27(s)(of I am a large quantity generator)or(b)fff aura smelt qm%y genersjco tMe. <br /> G,nwralo SigraW <br /> 19 "M I IN, 1��ay <br /> 16.Inlemational Shipments <br /> EIIIIII)MI.U.S. ❑aikm ft.U.S. Portofentywil: <br /> Transporter signature tfor exports ado: Date leaving U.S.: <br /> of 17.Transporter Acknowledgmard of Rocellet of Materials <br /> w <br /> Transporter 1 PArtmIlTyped Name Sigratille49r MOO Day Yea, <br /> 0 <br /> ij <br /> i7o i <br /> 18.Discrepancy <br /> lea.Discrepancy Indicallon Spa. ❑ <br /> Quantity [:]Typ. El Reah. ❑P.Mal RojectIon M1 El Ful R.*ft <br /> Mln*M Raftereme Number <br /> isomemats Facitty(orGeneraw) U.S.EPA to Number W 16'x 9 V 1. <br /> LL FaaW.Plane: <br /> 15c.Signahme of Alternate Facility(or Generator) In LMY <br /> 19.flaz�mous Waste Report Managernamt Malhocl Codes(8,god8s forhazad"MW tmaumml&Iposel,and mc yding atslems) Ai <br /> C <br /> 20.0e�gnaledFaqdy0�arOperatw.GerMmtionof=Vofbmm*ous=lsr;&WwedbyMmo*eooxDWOrdodkIM0182 <br /> 77 h rl wl"VP iv I <br /> EPA Form 8700-22(Rev.3-05) Previous;editions are obsolete. DESIGNATED FACIY.TYTO GENERATOR <br />