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. � � L/ <br /> Please printor type, � II�1lialilll Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Gensfalor ID Number 2,Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Number <br /> WASTE MANIFEST Z 1 '001798,028 VES <br /> 5.Gonoralors Name and Mailing Ad rens G ere s €te Ad sass(If different than malting address) <br /> ULISSA GALVAN. <br /> FED EXGGROUND �YSAME <br /> 5655 HOOD WAY <br /> enarafo,Pq&:9537?7217 <br /> 6.Transporter 1 Company Nang 830 aw U.S,EPA 1044i]fumber <br /> 7.Transporter 2 Company Name U,S.EPA ID Number <br /> 8.Designated FacUty Name and Site Address U.S.EPA ID Number <br /> VEOLLA ES TECHNICAL SOLUTIONS <br /> 7665 HIGHWAY 73 <br /> BEAUMONT,TX 77705 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit 13.Waste Codas <br /> HM and Paddng Group(if any)) - No. Typo Quantity WtJVoI. <br /> LION-RCRA HAZARDOUS WASTE LIQUID,(LATEX PAINT, 3 <br /> OIL) <br /> 5 D F 9 64 fl A OUTSO I SH <br /> 2,LU <br /> 1 <br /> 3. <br /> 4. <br /> 14.Specht Handling 1nslntctlans andAddltlonal Information ER Service Contracted by VESTS + Contract retained byenerraa�or l: nfe><s <br /> gen authority on initial tra>ospotter to add or substitute additional tlransporters on generator's behalf. -I- IM:71529 <br /> A0�11529 <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATtON: I hereby declare that the Contents of this consignmenf are fully and accurately described above by the propor shipping name,and are classified,packaged, <br /> marked and labefedfplacarded,and are in all respects in proper condition for transport according to applicable Intemadonal and national governmental regulations.If export shipment and I am tha Primary <br /> Exporter,I cordfy that the contents of this oonalgnmenl conform to the terms of the attached EPAAcknowledgmeatof Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(If I am a large quantity ganerator)or(b)(if I am a small quantity generator)is true. <br /> General sl4ifera a Printeffyped Name Signature Day Year <br /> CqxTA <br /> V.International Shipments r ' <br /> ❑lmm fo U.S. ❑Export from U.S. Port of ent€ylextt, <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 11.TrensponerAclo€aWgmentofReceipt ofMate" <br /> aTrans es t Pdnlac Signatus Mon Da Year <br /> O <br /> mi� <br /> a <br /> + Transporter 2 Printedffyped Name Signature Month Day Yea <br /> 4 IU <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication SpaceElFull Re <br /> ❑ Quantity El Type ❑Residue ❑Perm Rejection ]ec€ian <br /> Manifest Reference Number. 11 <br /> 18b.Atlsmate Facility(or Generator) U.S.EPA ID Number <br /> a <br /> v <br /> ua- Fadlity's Phone: <br /> Lu 18c.Signature of Altamate Facility(or Generator) Month Day Year <br /> h . <br /> 19.Hazardous Waste Report Management Method Codes(ts„codes forharardous waste treatment,disposal,and recydin9 systems) <br /> o � 2. 3, 4• ' <br /> 20,Designated Facility Owner or Ope or:Certlffcation of receipt of hazardous matedais covered by the manifest cept as noted in Item 1 <br /> P• r Day Year <br /> EPA Form 8700.22(Rev.12-17) Pre sus edition are obsolete. DESIGNATE FACILITY TO EPA's e•MANIFE/STT SYSTEM <br />