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Please print or type. � JUBI�I � lForm Approved.OMB No.2650-0339 UNIFORM HAZARDOUS 1 1.Generator ID Number 2,Page 1 of 3,Emergency Response Phone 4.Man 1 Tracidng Number WASTE MANIFEST 001798808 VES 5.Generator's Name and Mailing Address YULISSA GALVAN Genereta s Site Address('d different then malling address) FED IX GROUND SAME 5655 HOOD WAY TRACY,CA 95377.7717 ( Genretor's Phone: 9 830-1"60 F Trenspoder 1 Company Nemo U.S.EPA ID Number 1 V"IrOLIA ES TECHNICAL SOLUTIONS 7.Transporter 2 Company Name U.S.EPA ID Number 1 e,Dealgnatea Facility Name and Sita Address U.S.EPA ID Number VEOL1A ES TECHNICAL,SOLUTIONS, L.L.C. 1175 HENSLEY STREET Fadi s Phone: RICHMOND,CA 9� 01 8 9s. 9b.U.S.DOT Description(including Proper$Nppirg Name,Hazard Class,ID Number, 10,Containers 11.Tota] 12,unit 13.Waste Codas HM and Padang Group R any)) No, Type Quantity M'Arol, Y 1' UN1013,CARBON DIOXIPF, 3.7 331 W 1 C Y 1 P 2' NOON-RCAA HAZARDOUS WASTE.LIQUID. {LATKX PAINT, 331 r 3 D F 5 8 9 P 3. Vk&-.Q.CR.A HAZARDOUS WASTE SOLID,(NON-PCB 357 i 1 D F 3 12 P 4 14,Specht Handling Ensanrctbna and Additional lnfartntion ER Service Contracted by VESTS + Contract retained by eneraltor confers a eneyy wthoritq on initial trimsporterto add or substitute additional transporters on generator's behalf + I f ERG:170 W:71500 A: CWDGYLWRRT 7)W:71579 A:PTA071579 3)W:7701d ASLM173849 15. GENERATOR'SIOpFEROR'S CERTIFICATION: I herebydadare that the contents of this consignment are fully and accurately described above by the proparshipping name,and are dessified,packaged, marked and Iabo"placardod,and are in all respects In proper condition for transport according to applicable intemationaiand national govemmental regulations,If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of Vne attached EPAAdToxdedgmenl of Consent. I certify that the waste minimization statement Identified in 40 CFR 262,27(a)(if I am a large quantity geperator)or(b)(ff t am a small quantity generator)is true, Genera rslOflerors Printedrryped Nein Signature Oh Da Y r 16,Internationalstop"nt$ :❑Import to U.S. ❑Upon from U.S. Pari 01 entry/exit: Transportarsignature(for exports only): pate leaving U.S.: W 17.TranspgtarA*wMedgmontofReoeiplofMaterials LU1 T er 1 NM Name signs tAorhth Da Year Tra&Mrter 2 P?inteVypeTN.0rnoy Signature ay Year 18,Discrepancy 18s,Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Fag Rejection Manhat Reference Number. I8b.Niemate Fa*y(or Generator) U.S,EPA ID Number V ' ti Facilitys Phone: 18c.SIgnature'of Alternate Facility(or Generator) Month Day Year I 19. Hazardous Waste Repot Management MoUM Codes[La,,codes for hazardous waste treatment,disposal,and recycling systems) LU LU 1 /�`/ 2, y/! 3 �IY/ 4. E 20.Designated Facility Khmer or Operator.Conftdon of receipt of hazardous maledats covered by the manBeet except as Wed In Itom 18a Pdn ams Signature Month Day Year u/a 22 IZ/ EPA Form 8700.22(Rev.12-17) Previous editions are to. DESIGNATED FACILITY TO EPA's e•MANIFEST SYSTEM