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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS t,Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Mat[Heat Tracking Number c WASTE MANIFEST CARO 00 26 6 2 4 1 i877)818 00$7 001799424 VES 5,Generator's Name and Mailing Address 'YULISSA GALVAN Generator's Site Address(ti different than mailing address) FED EX GROUND SAME 5655 HOOD WAY TRACY, CA 95377-7217 Generators Phone: 209 830-2569 S.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 ?.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site AddressVEOLIA E,5 TECHNICAL SOLUTIONS, U.S.EPA ID Number L.L.C. 1125 HENSLEY STREET Fe611111 Phone: 510 233-8001 RICHMOND, CA 94801 C A T 0 9 0 0 1 4 0 7 0 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containere 11,Total 12.Unit 13.Wade Codes HM and Packing Group(if any)) No. Type Quantity Wt Nol. t NON-RCRA HAZARDOUS WASTE LIQUID,(LATEX PAINT, 331 p OIL) 1 D F 202 P Z 2. W C"J 3. 4. 14,Spodal HandOng instructions and Additional Information ER Service Contracted by VESTS 9 Contract retained by g�eneratar Confers ep�ylauthority on initial transporter to add or substitute additional transporters on generator's behalf + 1� 71529 A 15. GENERATOR11OFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,aid are classified,packaged, marked and labeledfplacarded,and are in all respects in proper Condition for transport according to applicable lntemational and national governmental regulations.ti export shipment and I am the Primary Exporter,I certify,that the contents of this consignment conform to the tamrs of the attached EPAAcknowledgmentof Consent. I certify that the waste minimization statement Identified in 40 CFR 252.27(x)(If 1 am a large quantity generator)or(b)('dl am a small quantity generator)is We, GeneretoeslOfforces PrintedlTyped Name Signature Month Day Year LORRLANE ORTA 1 0 1 9 2 1 ,j 16.intemaWrial Shipments ❑Import to U.S. Export horn U.S. Port of enlrylexll: Transporter signature(for exports only): Date leaving U.S,: 17.Transporter Acfu owkAgmentof Receipt of Materials Transporter 1 PdntWyped Name Signature Month Day Year SONNY CRUZ 1 0 1 912 1 Transporter 2Pdnte&TypedName Signature Month Day Year F 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Raiecdon ❑Full Re)ection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number r V LL FacliUys Phone:UO 1MonOm Day Year 18c.Signature of Wtemale Faculty(or Generator) a Z H19.Hazardous Waste Report Management Method Codes(i.s.,codes for hazardous waste treatment,disposal,and recycling systems) 2 3 4. 20,Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as nded in Bern 18a nn !Typed N I,� lA� ,`,, Signature Month Day Year EPA Form 8700.22(Rev.12-17) Previous edifions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM