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• i�io�iii�i�ii�i�iii�iiil <br /> Please pant or type.(Form designed for use on elite(12-pAchJ typewriter.) Forrn Approved.OMR No.20S0a39 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.Ermlganry Respmse Plane 4.Mandeal Tracking Number <br /> WASTE MANIFEST o f �a M'!7 ' OQ? 0 0 0 5 4 3 3 8 2 VES <br /> 5.Generators Name and Mailing Address pp4 ,��QC�App(�T��� SC Ganemmrs one Address(if dgterent gran mailing address) <br /> TOCK�-fO A CA P5 OB SAME <br /> Genemtq's Ptwne: 48^ HO i 4 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> VEOUA.ESTECNK l Alsou TnN.S N J D a 8 0 6 3 1 3 8 9 <br /> 7.Tmnsporler 2 Comperry Name US.EPA ID Number <br /> MPENViRON1;1JTALSERVICES CAT 0 7 0 5 2 4 2 4 ? <br /> S.Oasignaied Fatillty Name and SgeAddress U.S.EPAID Number <br /> VEOLIA ES TECHNICAL SOLUTIONS <br /> t704 W.FIRST STREET <br /> Faci(dys Phone: dZQ 3;34-5417 A.ZUSA,CA. 91702 D A D Q 4 $ $ Q a Q 3 <br /> 9a. 9b.U.S.DOTDesoisdon including Proper SNpping Name,Haunt Class,ID Number, 10•Container 11 Total 12 Ung <br /> HM and Pecking Group(d any)) No. Type tirY Quart 13.Waste Codes <br /> lMNul. <br /> 0 ttON-R.CRA.NAZAR.DOUS NAS E1(t1U(D,¢NKSUJDGE) 491 <br /> w 0 1 0 D M 04508 P <br /> 2 NON-RCRA IiAZARDOUS kdAS7)=SDIJD,(INK SDllLys 352 f <br /> 0 <br /> 3. 0 2 D M 006^9 P <br /> 4. i <br /> 14.Special Handling Instructions and Additional Information <br /> ER Service Cont—acted by VESTS + 1)W10083 A:RE-- TER(NDMA) i0 X 55GAL <br /> 2I l�'.10082 A:AZU-UEBtFUELINS 2 X 55GAL <br /> 15. GENEd and hi SIOFFEROR'S Q and <br /> am in all :(hereby declare that the contents of this censignmentare fully and a¢umtey list W gre proper ghipping name,and am dassifieq padmgad <br /> marked and labaledfplaardeq and are in all mspeas inpiper condition ferbanspon woording to applicable] and national <br /> Expatey l car*that the contents of Ws consignment conform m he terms of the attaChad EPAAclmowledgmenl of Consent 9ovemmenW mgulatibhs.8¢xpon shlpmerR andlam the Primary <br /> I argfy that Me waste miti mlution statement idened in40 CFR 262.27(a)(H I am a large quarAty generalod or(b)(if]am a small quantity ge rtrue. <br /> ahor)Is <br /> Genemtoesfolta rs Printedyt Na SignaW <br /> Month Day Year <br /> 16.Ntemational Shipman. D ^ <br /> ❑Import to U.S. q If <br /> Transporter signature(for exports only); LiE(I from U.S. Port of endylmdL <br /> 17.TransponarAdMoMedgment of Receipt of Materials- Date leaving U.S. <br /> Transporter 1 Pdntedrryped Name <br /> mFREDVs1ESEMANI SignatureMonthDay rear <br /> Transporter 2 Pdnted0'yW Name 0 2 2 3 1 2 <br /> F Signature Mora Day Year <br /> r18.Discrepancy <br /> 182.Discrepancy Indication Space <br /> ❑ Quantity ❑Typo ❑Residue <br /> �Partial Rejac6on ❑Full Rajeclion <br /> 18b,Alternate Facaity(or GenemtoN Manifest Reference Number <br /> —r U.S.EPA ID Number <br /> U <br /> 6 <br /> s+- Fadglys Phone; <br /> w 18a Signature ofAllemam Farlllty(or Genemtar) <br /> Mora Day" Year <br /> W19.Hazardous Waste Report Management Method Codes(1 e. , for hazallous waste tmabnem,oiisposal,and recycling systems) <br /> 1. Z 3. <br /> C <br /> 20.De naad.FacIt Owner er 0Pwwor..QpMfcaIJcn of receipt ofharzrdom materials covered by ga ma exa snored in It In 113a <br /> Y <br /> EPA F 670 22(Rev.3 05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF RMU1RED) <br />