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III 1111111111M11111111111111 Please print or tuns Forme Approved. OMB No. 2050.0039 UNIFORM HAZARDOUS 1. Generabr ID Number 2. Page 1 of 3. Emergency Response Phone 4. Mantlest Tracking Number VES WASTE MANIFEST C L 0 0 6 3 3 9 0 7 7 1 (87—n818-0or O Q 5 21055 5. Generator's Name and Mailing Address ADRsANA JNOCENCIO Gersretar's Site Address (d different titan mailing address) TAYLOR FARMS I NO MACARTHUR DR 1820 N MACARTHUR DR STE 700 STE 70.0 _ TRACY CA 95376-2831 TRACY, CA 55376- Generator's Phone: 209-?� 6. Transporter 1 Company Name U.S. EPA ID Number VEOLIA ES TECHNICAL SOLUTIONS N J D 0 8 0 6 3 1 3 6 9 7. Transporter 2 Company Name U.S. EPA ID Number I B. Designated Facility Name and Site Address&OLM ES TKCHNIC'a L SOLUTIONS, U.S. EPA ID Number L.L.C. i 1704 W. FIRST STREET` AZUSA, CA 91702 C A I3 0 4 3 3 0 2 9 4 4.t0 33r1-� t Facility's Phone: i 9a, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Clan, ID Number, 10. Containers 11. Total 12, Unit 13, Waste Codes No. Type HM and Packing Group (if any)) i Quantity "Nol. NAI 993, WASTE DIESEL FUEL, 3,111 D0[1I ul 214 '' I D M 3 00 P w z NON-RCRA HAZARDOUS WASTE LIOUIO,1 USED OIL) :11 4 DM 1600 P 3• NON-RCRA HAZARDOUS WASTE SOLID, (1L FILTERS) 223 i 2 D M 380 P 4. 14. Special Handling Instudons and Additional Information 4RService Contracted by VESTS + Contract retained b7'geneMOT confers agency authority on initial transporter to a4d or substitute additional transporters on generator's beh art + 1 } IRG: 128 W:877528 A:AEU=FUEL>7 2) W:i60222 A-AZU-FUEL>7 3) W:474914 AAEU-BSLDEBR.S(NS 15. GENERATOR11OFFEROWS CERTIFICATION: I hereby declare that the crbrrferds of kris consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeledrplecarded, and are in all respects in proper condition fcj transport according to applicable international and national governmental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms1of the attached EPAAcknowledgment of Consent. I certlfy that the waste minimization statement Identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if t am a small quantity generator) is true. t Generator's0lfejor's Printedfryped Name Signature Month Day Year Y u 4� !" 0 4 0 2 2 0 j 16. In al Ship is ❑ Import b U.S. ❑Export from U.S. of entylexit Transporter signature (for exports only): Data leaving U.S.: LU 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 PriName Signature Month Day Year f� �_ � 164 6-1- Z Transporter2 PrintedlTyped Name Signature Month Day Year 18. Discrepancy 18a. Discrepancy Indication Space quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full R 'action Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPID Number J U LL. Facgitq's Pitons: W 18c. Signature ofAkamale Fadlitir (or Generator) Month Day Year a z 19. Hazardous Waste Report Management Method Codes (i.e., codas for hazardous waste treatment, disposal, and recycling systems) � 1. (f 4. 21). Designated Facility Owner or Operator: Certification of 1ppt of hazardous materials covered by the manifes1poepA noted in Item 18a yped Name �� Si Month Day Y EPA Form 8700- (Rev, 12 -IT) Previous editions are obsolete. nFclr.....:n II mV Tn r-De*a e.ueQ%FQ