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Please print or type. Form Approved.OMB No.2050.0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone-` 4.Manfteet racking umbar WASTE MANIFEST CAR000266247001799493 VES S.Gonoratods Name and MaliingAddross Genoroloes Site Address(I(dl#erent tfrhn malling address) YULISSA CrALVAN FED EX G'rROUND SAME 5655 HOODWAY TRACY CA 93377-7217 GenetalorslPhone: 209 83171-2ilig B.Transporter 1 Company Nome U.S.EPA ID Number VEOLIA ES TECHNICAL SOLUTIONS N J D 0 6 0 6 3 1 --3 6 9 7.Transporter 2 Company Name U.S.EPA ID Number TRISTATE MOTOR.TRANSIT CO. M O D O 9 5 0 3 8 9 9 6 8.Designated Facility Name and Site Address U.S.EPA ID Number 'V•EOLIA ES TECHNICAL SOLUTIONS, L.L.C. 1704 W.FIRST STREET FaciiilysPhone: AZUSA,CA 917.07 C A 1) 0 0 8 3 0 9 9 0 3 ga, Pb,U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers , 11.Total 12.Unit 13.Waste Codes HM and Packing Group(Ir any)) No, I Typo Quantity WI Nol, o Y 1• UN1263_ PASTE PAINT RELATED MATERIAL INCLUDING F003 D001 331 F ' �I�l O`I�II IgNING, DRYING,REMOVING,OR REDUCING 1 D M 2 7� P, Foos, D035 oil ng Mgg3 u Uj X 2. AETON � TLT A i%ELF�URAI+SI)� 3 IIS F003 331 gg3 p F pig �� 1 C F 34 P DOOI X F003 U057 U739 I D F 1 8 2 P nos U159 212 X 4- UN2924 �ASTE FLAMMABLE L18U1DS CORROST& D002 DE�E3E �YCOL MONBUTIfETHER,SODIUM OI 1 C F 45 P 331 14.Spades Handling InstructIons and Additional Information ER Service Contracted by.VESTS -I- Contract retained by enerator ConferS agent atlthori on initial Iran oiler to add try substitute add3itional trans artery r1 a err��ttar's behalf •ff• 1 ERG i 8 yU; O4g6 ARCI-90945-0312 23 ERG:129W.71501 A:AZURPK3 3)ERG:12B 7.y)tf04 DPK3 4)EIRG:l32 :71N0 A U IBB 15, GENERATOR'SfOFFEROR'S CERTIFICATION:I hereby declare lhatthe contents of this consignment are hrtily and accurately describod aboveby th proper shipping name,gird are closslffed,packaged, marked and labeledlptacarded,and are in all respects In proper condl0on fartransport according to applicable inlernationaland national governmental ,gulallons.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment Conform to the forms of the attached EPAAcknowladgment of Consent, I corilly that the waste minimization stalement idontifled In 40 CFR 262.27(a)(111 am a large quantity generator)or(b)V I am a small quantity fieneratoq Is true, GoneratorslOfferor'sPdnlednWedNameS nature month Day Year LORRIANE ORTA 18,International Shipments ❑Import to U.S. El Export from V.S. Podef ensrylexit: Transporter signature(for exports only): Date leaving U.S.: fe 17,Transporter Acknowledgment ofRaceiptofMaterials LUTransporter 1 PdnteCyped Name Month Day Year Stgralure a SONNY CRUZ 1 01 1 9 12 1 Transporter Prinledityped Neme Signa urs Month Day Year, r_ 1 A—a C . 18.Discrepancy 18a,Discrepancy Indication Space El Quantity Type ❑Rasldus ❑Partlat Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Fadlity(or Generator) U.S.E0 ID Number U - rar- FadlIvs Phone: 18c,Signature of Aitemale Facility(or Generator) Month Day Year 10.Hazardous Waste Report Management Method Codas(I.e.,codes for hazardous waste treatment,disposal,and recycling systems) ' 3, 4. 20,Designated Facility Own or Ops tor:Certification of rocelp hazardous materfols Covered by the manifest except as noted in Item 18a PrtntedlFyped Name Signature f Month Qay Year EPA Form 8700.22(Rev.12-17) )Previous edillorrs aro ebsolo a, DESIGNATED F CII TO EPA's e•MANIFEST SYSTEM