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ell I� 4I�� �Il�lu <br /> Phase print or type. Form Approved.ONtt3 No.2050.0039 <br /> UNIFORM HAZARD0131 1.Generator ID Number 2.Page 1 of I Emergency Response Phone 4.AlanMaat Tracking N, bar <br /> WASTE MANIFEST 1001798002 Y E,S <br /> 5.Generators Name and Mailing Address YULISSA GALVAN Generator's She Address(ff different than mailing address) <br /> 565 HOOD WAY SAME <br /> TRAC,Y', CA 95377-7217 <br /> Generate s Phone: <br /> 8.Transporter 1 Company Na U.S.U.S.EPA ID Number <br /> VEOLIA ES TECHNICAL SOLUTIONS <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Deslgnated Facility Name and SlteAddress U.S.EPA 10 Number <br /> VEOLIA ES TECHNICAL SOLUTIONS, <br /> L.L.C. <br /> 1135 HENSLEY STREET <br /> Face s Phone, RICHMOND,CA 44801 C A <br /> ga 9b,U.S,DOT Description(induding ProperShipping Name,Hazard Class,ID Number, 1o.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Quantity Wtivol. <br /> Ce 1' NOHAZARDOUS <br /> ON-RCRA WASTE LIQUID, (LATEX PAINT, 331 <br /> 5 D F 1010 P <br /> Z 2. <br /> LU <br /> tD <br /> 3. <br /> 4. <br /> 14,Special Handling Instructions andAddibmal Information ER Service Contracted by VESTS -I- Contra rgt�ed i e ,�p c nfers <br /> M'A(g1lg�ority on initial tt-ansporterto add or substitute additional transporters on generatorrsvehalf. �- L :�15�9�, <br /> 15. GENERATOR'910FFEROR1 CERTIFICATION:I hereby declare that The contents of this consignment are fully and accurately described above by the propershipping name,and are classified,packaged, <br /> masked and tabelodlplacarded,and are in all respects in proper condition for transport Kowding to applicable intemaWnaland national govemmantal regulations.9 expert shipment and I am%a Pdmary <br /> Exporter,I car*that the contents of this consignment conform to the terms of Oto attached EPAAckswwledgment of Consent. <br /> I cartify that thewaste minimization statement klendod In 40 CFR 282.27(s)(if I am a Ina quantity generator)or(b)(11E am a small quantity generator)is tree. <br /> Generstoes/Oflexes Pdntad Typed Name SignatureMon Da ear <br /> 1 16.International Shipments <br /> ❑Import to U'S. ❑Export from U.S. Port of entry/exit <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter AdmowoOgmentof Receipt of Maledals <br /> or 1 Pdn iedName Signs Day Year <br /> sa <br /> - MUM <br /> N Tsars r nt yped Name 5lpnahrre Montih Day Y <br /> 121 <br /> f8,Disaepancy <br /> 18a.Diskxxepancy Indication Space ❑ Quantity FIT, ❑Residue ❑Partial Rejection ❑Fug Rejectbn <br /> Manifest Rofomnoo Number. <br /> 18b.Atlemala Facility(or Generator) U.S.EPA ID Number <br /> cs <br /> U. Facility's Phone: <br /> 2 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(is„codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1 14141 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Cefficatlen of recelpt of hazardous materials covered by the manifest except as acted in Item 18a <br /> PAtodfTyped Namp... ignatum Month Day Year <br /> rot ev Iz� <br /> EPA Form 8700-22(Rev,12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />