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Please print or type. Form Approved,OMB No.2054-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,Manliest Tracking Number WASTE MANIFEST 1001794305 VES 5.Generators Name and Melling Address WILMA(MLVAN Generators Site Address(if different than mailing address) FED EX C ROU M S1AM13 56SS HOOD WAY T1t a CA W77-72J7 Generators Phone: 6,Transporter 1 Company Name U.S.EPA ID Number MITA HS TECE41CAL SOLVEM N J D O 6 0 6 3 1 3 6 9 7.Trilftsporter 2 Qompany Name /+G okil O ^ U.S.EPA Number lq 8. Dosignatea Facility Name and Site Address ri(11 U.S.EPA ID Number VBOMES T$CHNICALSOIEMM 7WBKWAY 73 )8LMAWff.TX 77M Fadlity's Phone: AN 23&AIDS IT X D 0 0 0 9 3 8 8 9 6 ga- 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number, 10.Containers 41.Total 12.-Unit 13,Waste Codes HM. and Packing Group(f any)) No, Type quantity W11vol, O X1. C1t9317S,WAM� ?8� CC INTAWl B FLAMMABLE F003352 t UQM,--a (lam CONT"MIM V= SQLVEM�4.1.H 1 D F 45 P DWI OMM 9H U.1 z' NO"C"UMMUS WASTE 1XM(UUXPAW 331 3 D M 669 P 0=1 913 3. 4. 14.Special Handling Instructions and Additional tnfarmatian 1$Savim byVEM * Cm*M yA mumWoinfin AyU�a��tpl fit}rtes`pa�rtar�gr►�1��dfMlar�/w��tilt�etiddt8oladtraeiponmalat8atngn�ba + 1 1?t�133W:7ISGA 1M '2) -.7I NA.i1�'W11.7/r) 15, GENERATOR`SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labefedlplacarded,and are in all respects In proper condition for transport according to applicable International and national governmental rAgulations.It export shipment and 1 am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowiodgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(If I am a large quantity generator)or(b)(if f am a small quantity generalor)is true, Gonaralo slOtierors PrinledlYyped Name Signature Month Pay Year ,,,,,r 16.international Shipments ❑Import to U.S. ❑Export from U.S. Portof entry/exit: Transporter signature(for exports only): Date leaving U.S.: ^ W 17,TransporterAcknovAedgmentofReceipt ofMaterials Transporter 1 Printed/Typed Name Signature Month Day Year 0 111=SHAS 19 910 112 1 5E Tr ns rter 2 Printed ped Namep 5 Month Day Year Y V 16.01smpancy 18a,Discrepancy Indication Space ❑ quantity 0 Type ❑Residue ❑Pargal Rejedion ❑Full Rejection Manifest Reference Number: 18b.Ailemate Facility(or Generator) U.S.ERA ID Number J ' U LL Facifity's Phone: w 18c.SlgnalureofAltemateFacility(or Genarator) Month Day Year d V3 19.H rdeus Waste Report Management Method Coda (i.e.,codes for hazardous waste treatment,disposal,and recycling systems) W 3, 4. Qvv-)�'-ko 26. osignaled Facility Owner or Oparalo . rlificatlon of receipt of hazardous materials covered by the manife sept as need in Item 18a ' fore on Yp�r EPA Form 8700.22(Rev. -17) Previous ediffons are o alete. LDESIGNATED I=A LITY TO EpA's e•MANIFEST SYSTEM