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r <br /> NON-HAZARDOUS rnerator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Waste TrwMng Number <br /> WASTE MANIFEST CAL00029875i 1 209-612-6969 G <br /> 5.Generator's Name and Mailing Address Generators Site Address(d different than mailing address) <br /> F 8 H CONSTRUCTION 4545 E.WATERLOO <br /> P.O.BOX 55245 STOCKTON,CA 952155 <br /> STOCKTON,CA 95205 <br /> Generators Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> SHOP HAZARDS SOLUTIONS CA0000646497 <br /> 7.Transporte Comp X Name U.S.EPA ID Number <br /> S l L"''C' Ok)✓ar <br /> 8.Desig ed Facility Name and Site Address U.S.EPA ID Number <br /> VEOUA ES TECHNICAL SOLUTIONS,LLC AZ0000337360 <br /> 5736 W.JEFFERSON ST <br /> PHOENIX,AZ 85043 <br /> Facie s Phone: 602-233-2955 <br /> 9.Waste Shipping Name and Description 10.Containers 11.Total 12.Unit <br /> No. Type Quantity WtJvd. <br /> 1. 1 <br /> UNIVERSAL WASTE-MSC E-WASTE FOR RECYCLING r * ;' <br /> 3. <br /> 4. <br /> 3. Special Handling Instructions and Additional Information <br /> PRORLE#317740 <br /> 14.GENERATOR'S CERTIFICATION:I certify the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br /> s Prirrtad/fyped5� ar Month Day YeL,. SiT <br /> .j i .International Shipments <br /> F Import to U.S. ❑Export from U.S. Port of entry/exit <br /> Transporter Signature for exports only): Date leaving U.S.: <br /> cc 16.Transporter Acknowledgment of Receipt of Materials <br /> F <br /> Transporter 1 rintedRyped Name Signature Month Day Year <br /> O <br /> CO)IL 10 Ice <br /> Transporter 2P'I d/T d Name Sign a Month Day Year <br /> a 7 <br /> � > GG• 17 <br /> 17.Disci <br /> 17a.Discrepancy Indication Space <br /> ❑Quantify ❑Type ❑Residue ❑Partial Rejection Full Rejection <br /> Manifest Reference Number. <br /> 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> tai. Faciltlys Phone: <br /> m 17c.Signature of Alternate Facility(or Generator) Month Day Year <br /> t— <br /> a <br /> z <br /> 1 B.Designated Facility Owner or Operator.Certification of receipt of materials covered by the manifest except as noted in Item 17a <br /> PrintedlrqIMM� Signature � Month Day Year <br /> v3 o4 <br /> 169-BLS-C 6 10497(Rev.8/06) DESIGNATED FACILITY TO GENERATOR <br />