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Please pdntorty �IIg I �II Form Approved.OMB No,2050-0039 <br /> UNIFORM!HAZARDOUS 1•Genereior ID Number =Plage 1 of 3.Emergency Response Phone ManlNat TracIdng Number / �+ <br /> WASTE MANIFEST ©O 9 Y E�7 <br /> 5,Generators Name and Mailing Address Yf RA Goneralor's Site Address(•d different than melling address) <br /> FfD EX GAOUM RAME <br /> 3&3 UIX110 WAT <br /> RM CA WM-7217 <br /> ph": 2W 23MM <br /> S.Transporter 1 Company Nam U.S.EPA ID Number <br /> VWLIA ES TBCOMCAL SOL.t; n(M N I D 2 1 0 6 3 1 ALA 9. <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> W MgVMVNMWrAL='KCW C A T 0 0 0 6 2 <br /> B.Designated Facility Name and Site Address U.S.EPAID Number <br /> VOOL iA ES TBa*Ut&$ilfLVMNII <br /> Li.C. <br /> 1115 amd= r <br /> Fadil s Phone: Ramon,CA 54101 <br /> ga. 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 1 D,Conte! 111.Total 42,Unit 13.Waste Codes <br /> HM and PackingGroup(#any)) No. Type Quantity WINNI <br /> W x 1. TN120,WARTS PAINT RELATED MATBBIALa 3,II,RQ DOM <br /> � �1) <br /> 4 DM 1200 P 331 <br /> LU <br /> LU <br /> x 2. <br /> OTYDROCZMC A=C d,II <br /> 3 D If 240 P <br /> 3' NEW41"A RVARDMA WAt3 M IXQ=r aAT'EX PAINTr T4I <br /> OEL) <br /> 1 1] M 400 P <br /> 4. <br /> 14.Special Nand Ing Inst wOons and Additlonal Informs4on )l.gavix UmOmWi by + apt I W ommom wmftm <br /> CM mdummipmurto @&at InS tbu ddi' ' b". + 1) 1U W,71�490 At <br /> 2)MR&1554 VM87 A:AE PTAYB= 3)W 7� <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and a=ralely described above by the proper shipping name,and are classified,packaged, <br /> marked find labeledlplacsWed,and are In all respects In proper condition for transport according to applicable International and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certity that the contents of this consignment conform to the tarns of the attached EPAAclutowledgment of Consent <br /> I certfy that the waste minimb on stalement Identified In 40 CFR 282.27(a)(K I am a large quantity generator)or(bj(d I am a small quantity generator)Is true. <br /> Genera rslofferors PrintedfTyped Name / Signa Month Day Year <br /> r 16.Intemational Shipments ❑Import to U.S. <br /> ❑Export heat U.S. Port of entrylaxit <br /> Transporter signature(for exports only): Data leaving U.S.: <br /> me 17,Transporter Ackrwwladgmentof Receipt of Materlals <br /> L2Trans r 1 PrinledlTyped Name Slpnatum Month Day Year <br /> a -e C <br /> = Transporter 2 PrintedfTyped Name Sig Month Day Year <br /> 4[� e 4,L 44 JZ <br /> 18.Discrepancy <br /> 189.Discrepancy Indication Space ❑ quantity ❑Type ❑Residue ❑Partial Reisa. ❑Full Rejection <br /> Manliest Reference Number. <br /> 10.Alternate Facility(or Generator) U.S.EPA ID Number <br /> LL Facilit+s Phone: <br /> 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> y19,Hazardous Waste Report Management Method Codes(I.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2. / 3. 4. <br /> 20.Designated Facility owner or Operator.Certification of receipt of hazardous materiels wvered by the manifest except as nrxed in Item Me <br /> ntedlT ane Signature Month Day Year <br /> 40 <br /> �0 �✓ <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY 10 EPA's e-MANIFEST SYSTEM <br /> I <br />