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r <br /> l�gllllll�lli��la <br /> Please print or type. Form Approved.OMB No.205M39 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3,Emergency Response Phone 4.ManhatTracking Number <br /> WASTE MANIFEST 1001798449 VES <br /> 5.Generators Name and Mailing Address YERMU GALVAN Gerrerator s SNe Addrese(d different than mailing address) <br /> FED IDC(MOUND &AM <br /> SOS HOW WAY <br /> gMCA M".T217 <br /> Phone: <br /> 8.Transporter 1 Company Name U,S,EPAID Number <br /> V'11>D1: BB N J D 0 1 0 6 3 1 3 6 9 <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facililyy Name and Site Address U.S.EPA ID Number <br /> VBMM S .AZisoLunma„ <br /> LLQ <br /> 1125 111014IBY 211W <br /> Fadi V Phone: RICERMOND,CA 9WJ C A T 0 8 0 0 1 4 0 7 9 <br /> 9a, 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, to.Containers 11.Total 12.Und 13.Waste Codes <br /> HM and Padckrg Group('d any)) No. Type Quantity WLN01. <br /> o X 1. UN11044SMEAK. ►22 141 <br /> a� 1 C Y 1 P <br /> LyX z' UK17(A WA8M 001w0WX L11J.a(KEW D002 <br /> HY1IIK0)MK 50LK1M HVPOC=DKM 11.%RQ <br /> 2 D F 399 P 112 <br /> 3' N Wl<IC A H9AZARDOUS WAM LIQEW (LAMIX PAINT. 331 <br /> S D M 1131 P <br /> 4. <br /> 14.Speaal Handling fnstmctions and Additional!fniormatlan Eft 8m w Qqn i*rVEM + Ow*M>--�� down <br /> �� �) WIW bbtQI$4 W'11=10 l duli�' erlw�lPolllQoa b"K + 111 ]2]WM33=4 <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby dedore that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dass€fied,packaged, <br /> marked and tabeledfdacarded,and are In all respocls in proper condition for transport according to applicable International and national governmental regulations,If expod shipment and I am the Primary <br /> Exporter,I certify that the contents of this oonalgnment conform to the terms of the attached EPAAclmowlodgment of Consent. <br /> I corlify that the waste mfnimitallon statement Idenfl iod in 40 CFR 282,27(a)(If I am a large quantity generator)or(b)(d I am a small quantify general&)Is true. <br /> GeneratorslOfferces PdnLWKyped Name Sig ahs Month Day Year <br /> 16.Intematlona€Shipments <br /> Import to U.S. ❑Expodf .U.S, Pod of entrylexil: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17,TrenspoderAdmowledgment of Recelptof Materials <br /> Transporter 1 PdnladlTyped Name Signature ,� Month Day Year <br /> � 3 /�C� <br /> Transporter 2 PrintedlTyped Name Signatlito Month Day Year <br /> 18.Discrepancy �tt <br /> 18a.Discrepancy Indication Space ❑ quantity n Type ❑Residue ❑Parts]Re)ecdon ❑Full Rejection <br /> Manifest Reference Number. <br /> 184,Aftemale Facility(or Generator) U.S.EPA ID Number <br /> U <br /> LL Facility's Phoho; <br /> 19c.Signature of Altemate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(I.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> � 1. // 2. 3. 4. ' <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as oiled kr item 18a <br /> Pdm2a�4v_ <br /> 5 nature Month Day Year <br /> /� 10 S L3 <br /> EPA Form 8700-22(Rev,12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />