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p{aeae mint or FormQ p ved.'OMB Irv.2050•aD38
<br /> UHIFORIN DOUS 1.Generator ID Number I 12.P age t of s. parwY Response I'lwns ®O�1 Z(�C?O O i E�+
<br /> WASTE MANIFEST C A.R 0 0!2 6 ,6 2 4 7 - y
<br /> 5.Generators Nana and Malting Address YElLISSA,CxALVAN GanerateraM Address(If different than mellfng address)
<br /> FED EX GROUND
<br /> 655 HOOD WAY
<br /> RACY, CA 95377-7217
<br /> Generators Phone: ,
<br /> 8.Transporter 1 Company Name r U$.EPAID Number
<br /> FOLIA ES TECHNICAL SOLUTIONS. N J D 0 6 0 3 1 3
<br /> 7.Transporter 2 Company Name U.S.EPA ID Number
<br /> R1SThTE MOTOR TR4NSIT CO. Im a D 0 9 5 0 3 8 9 9 8
<br /> 8,Designated Fadilty Noma and SlfPAdd U.S.EPA IO Number
<br /> 'rOLIA�S TSCH�IICJI,L saLUTIONS,
<br /> 1704 W. FIRST STMT
<br /> Fadi) sPhone: 626 334,5
<br /> 3 - 117 AZU94 CA 91707 C A D 0 0 8 3 0 2. 9 0 3
<br /> 9a, Ob.US,DOT Description 6dWN Proper SNppkmg"—,)l ord Class,ID Number, 10.Contalners 11,Total 12,Uri! 13.Waste Codes
<br /> HM and Paddng Group(If any)); No. type ANY "Not.
<br /> V' 1 UNI993 ASTgg FLAMMABLE LIpUIDS,a.a s. D001
<br /> o I T�rETRO U DISTILLATES APFITHA), MbRHE11~IDINB
<br /> CrLUCONATE,3,IL RQ(D001� I D F 2.01 P . 331
<br /> X 12-UNp3175,WASTE SOLIDS CONTAININCIAAM LB F003 357
<br /> SOLISDiSs . SRlB CONTAMINATED WITH 1 D F 4,1 P DQO1
<br /> }!• s UN1748 AS,TT E 111 1HffCHLQR1TE T DRY D001
<br /> W[Tf AVAILA.B $�F L �$
<br /> Si 1i.RQ
<br /> 1 DF 93 P 181
<br /> X a.UN2465,WASTE DICHLOROISOCYANURIC ACID SALTS, D003 181
<br /> 5-1,11
<br /> ' I C F 7 P D001
<br /> 14.spedal Handltng fnetrudons ani AaattbnaI Information ER Service Contracted by VESTS -f- Contract retrdned by gener r con6e
<br /> AZa env�yy�authlori on nidal p'Msoarter-to ad or sn stn to addig'oa�al tri a apI gen r' a elf •�• 1 g� e 7 5p�
<br /> �JRPX3 PAd. 2�EP-0:133W,71i�8 A H5�6795 3 ERG:Ii�W�! SU1 A I1 S L�ABPA K } R iO W:7 50i A:
<br /> IIRP01 LAABPACK, r
<br /> F ,
<br /> 15, OENERATOR'S10FFEROR'S CERTIFICATION;I hereby declare that the ogritante of No consignrbent are fuly and awsately decaibed above by Cry WW 0904 name,Ord are da ffw,pedraged,
<br /> marked and lebak dlplawded,and-are In al rospeds kr proper canditlon for#ansportacwrift to applicable Intema8oiWand nerbW govenunental t6ationa,If export shipment and t am the Primary
<br /> Exporter,I carol Mat"contents yf thin consignment odnform to the terms of the attadned EPAAdama+dedgmom of Conant,
<br /> I cerltfy that dme waste mlrmtrntzatbn atatarrment tdentifiad in 4DCFR 292,27(a)(K I am a large quantltygenerator)or(b)(HI am a small rjusndty generator la true,
<br /> Pon era�slOfferors PdmtedRypad Name e
<br /> moot Y,
<br /> io
<br /> 6,risme Shipments Import to U.S. ❑Expert from U.B. Part of entryra*
<br /> Transporter signature(for exports only): Dans Wft U.S.;
<br /> 17.Transporter RduwwledgmOntof Reeelpt of Materials
<br /> o� rtes 1 Prints N Month Da Ye
<br /> Transporter 2 n! Nemo " SlgneNre aY Year
<br /> 18.Discrepancy i
<br /> 18s,Dlscreparmcy l,sdtca8on Space ❑ Quantlty Type ❑Realdrre ❑Pedlar Rei d. El Fdi Reysctfon
<br /> t 64ardFest Reference Number:
<br /> f8b,Alternate Faddy(or Generator) I U.S.69AIDNumber
<br /> U
<br /> u`C. Fadiity's Phone;
<br /> w 18x Signature of Alienate Fadlity(ar Genorator Month Day Year
<br /> 19,Hazardous Waste Report Management Me Codes(Le.,medoo for hazardous waste treatment,disposer, recycling systema)
<br /> 1. 2,
<br /> 20.Designated adlfty Owner or Operator:Cergft don of of hazardous rgaterlals covered by to mranlfaetexoW as rmated In Item 18a -
<br /> PdntelTyped erenature Ih Do Year
<br /> tv)x—0- — X I I C L'. ) 1 (Q
<br /> Z�
<br /> EPA Form 8700-22(Rev.12.17) Previous ed(fiwma are obtiblela, , DESIGNATED FACILI EPA's 9-MANIFEST SYSTEM
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