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Please Dirt or tvoe. <br />�Iflf�f fff�f ��ff®ffi!!��llil�� <br />EPA Form 6700 -ZZ (Rev. 12-1 r) PreV10W MOM are ODsaere. utslUNA I to rALMd f T I V trA-s e-mAnl r co I a T o i Cm <br />rtxm nwPruveu. r. my M. 'dV'*-Wj?j <br />UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. EmeWricy Response Phone jok Marital T=Mng Number <br />WASTE MANIFEST C A L 0 0 0 3 3 9 '0 7 7! ..Yl (877) 818-0087 001516149 VES <br />S. Generators Name and MaiNng Address ADRIA.NA INOCU CIO Generators Srm Address Cit difarent Than mailing address) <br />TAYLOR, FARMS 11320 MACARTHUR Did <br />1890 N MACARTHUR DR STE 704 STT 700 <br />TRACY, CA. 95376-2831 i TRACY, CA. 93376 <br />Generators Phone: 209 <br />6. Transporter 1 Company Name U.S. EPA ID Number <br />VEOLIA ES TECHNICAL SOLUTIONS N J D 4 2 0 6 3 1 3 6 9 <br />7, Transporter 2 Co�m/panry;�aTa C 11 U.S. EPA ID Number <br />AAP /V V t�� f V V1�� C�+-rcoo(P)M <br />8. Designated FadlHy Name and Site AddressVE GLIA ES TECHNI JA.L SOLUTIONS U.S, EPA ID Number <br />L.L.G. <br />I704'p7. FIRST STREET <br />AZUSA, CA 91703 <br />FacHiy's Phone► �� � 3 �'� "� i I7 0 Q 9 3 a 2 9 0 3 <br />ga, <br />9b. U.S. DOT Desa"on (induding Proper Shipping Name, Hazard CI s, ID Number, <br />10. Contat±rers <br />11, Total <br />12, Unit <br />West- Codes <br />No. <br />type <br />HM <br />and Packing Group Cit any)) i13. <br />Cluantily <br />Wt.Nol. <br />1• <br />NON-RCRA HAZARDOUS WASTE LIQUID,,f,USED OIL) <br />221 <br />o <br />; <br />I <br />D M <br />400 <br />P <br />2. - CRA HAZARDOUS WASTE SOLID, OIL FILTERS} <br />223 <br />W <br />c� <br />1 <br />D M <br />250 <br />P <br />3. <br />4. <br />14. Spedal Handling Irnshdions and Additional Inbanation ZR SeMce Contracted by VESTS + + Contract retained by generator <br />confers amauthority �authority on initial trans or err t0 fl or subsktate additiorlal �tsporbim on generatoVs behalf -I- 1) W: <br />160222 AAZU-FUEL>7 2) W-.47491A.:AZU SLDEBRS(NS <br />1S. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby dedae that the tents of this consignment are fully and acarrataly described above by the proper shipping name, am are dawAW, padsaged, <br />marked and labeledlpiecarded, and are th all respects in proper eomdtion fpr transport aomrft to apocabte ntemelionalarid natkmal govemmental regulations. ff export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment oonfonn to the tam$ of the attached EPAAdTawledgment of Consent <br />I certify that the waste minimization etAannent identlfied In 40 CFR 262.270i Cd I am a large quantity generator) or (b) (dt am a sinal quantity generator) is true. <br />Gene rot's PdnbdTyped %m Signature MDnth Day Year <br />rJ4 1042519 <br />16 nts ❑ import to U.S. ❑ Export from Ld Port of antrylendt <br />? <br />Transporter signature (far exports only): Date leaving U.S.: <br />17 inert of Receipt of Materials <br />pW <br />//A <br />Z <br />Transporth 2 Print"Typed Signature Month Day Year <br />16. Discrepancy <br />16a. DisaepanCy Indication Space ❑ ouanthy ❑ Type ❑ Residue ❑ Partial Rejection ❑ Fug Rejection <br />Mani{est Reference Number: <br />18b. Mllemata FacdW (or Generator) U.S. EPA ID Number <br />J <br />V <br />Faditys Phone: <br />LU <br />18C. SgmtLre of Abrnate Facility (or Generator) <br />Mordh Day Year <br />S2Waste <br />18. Hazardous Report Management Method Codes (LeL., oodes for hazardous waste treabnent, disposal, and recOnng systems) <br />� <br />T <br />2. <br />{ <br />(11 3. <br />ljtrazadDus <br />4. <br />2D. Designated Facility Darner or Operab7r: Cedkation of receiptofh materials Covered by the manifest except as ndad In Hem 16a <br />y* Name V�CMqaFMSt(o c� Mand Dey Year <br />EPA Form 6700 -ZZ (Rev. 12-1 r) PreV10W MOM are ODsaere. utslUNA I to rALMd f T I V trA-s e-mAnl r co I a T o i Cm <br />