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BE�lll��f���l��� <br /> Please print or type.. Form Approved.OMB Na.2061}•0439 <br /> UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,Men fast1fackingQ `Number �+ <br /> • WASTE MANIFEST f5 2 4 7 Y 10017 9 6 2 7 VES <br /> 5.Generators Name and Malgng Address 'YUU99A OAGYAN Generators SltsAddress(If 0arent IN mailing address) <br /> FED ffiC Cf8OLM <br /> 505 EMM WAY <br /> TRACY,CA MM-7317 <br /> Generators Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> V®OIdA I�T�IClIIr$OIrQ1I41Q9 N F D q S O G '� � � G 9 <br /> 7,Transponer2 Company Now U.S.EPAD Number <br /> TRWATUMOMTRAMSM !I[ 0 D 0 9 3 0 3 $ 9 9 8 <br /> 8.Designated Facility Name and Site Address U.S.EPAID Number <br /> V�IiA$S'r�f�CAE.�� <br /> 1704 W.PEft Fg' <br /> Farad s Phone: tjAZU R CA 9l7di C A D G 0 8 5 0 2 0 0 1 <br /> ga 9b.U.S,DDT Description(including Proper Shipping game,Hazard Gass,ID Number, 10,Containers 111TOtel 12,Unit 13.Waste Codes <br /> HM and Packing Group(If any)) No. Type Quantity WIJVaI. <br /> G X 1 UN120,WASTH PAINx RUL4T®M'ATUM 3,IL AQ �a0! <br /> ! Du 178 P 731 , <br /> LIJz' Chi WABM FLANE ,p a,s., Fes! 1107 , UM <br /> {d!(� AGWMM NOPOPAN04.A. <br /> 3 DM 413 P POM U19 Z2 <br /> x 3' LW914Q 't�A13TS 9iYI D(fffid P�il]�78 AND P�1[YAiBc1uG DIVII n= <br /> 1 C F 91' P 1171101 891 <br /> X a. R +13l0�.Wi118TS4ROAl+ O PSRMSTit F UQ= i1 M DOM <br /> PfflWWM3h 3.2(8) ! C'It 3 d P BM33! <br /> 14.Spodal Handling InstructIons and Add#Ronal Information E.3comigo oWd ewe b + 'zOt*W by OQ� <br /> 2)Em aB W. GN AAS #)ftba�W'M �� I. 4)� W�lk <br /> 15, GENERATOWSIOFFEROR'5 CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately domAlood abgye by th4 proper skipping name,aryl arstlasslfied,packaged, <br /> marked and labeled/placarded,and are In ail respects In proper condition for transport according to apploable international and national govemmenl it r uteuona.If exportshlpmanland I am the Primary <br /> Exporter,I cortify that the contents of(his oansignmentconfomr to the terms of,the attached EPAAdmo0odgment of Consent <br /> I corfify that the waste minimization statement Identified In 40 CFR 262.27(a)(If Lam a t4rgs Quantity generator)or(b)(III am a small quantity generator]Is tree. <br /> Goneralarst0gotoraPdnledfi'ypedName S na Me* Do Year <br /> 16,International Shlpmenfs V <br /> ❑Import to U,S. ❑Expod from U.5. Partof anirylexlt: <br /> Transporter signature(for exports only): Data loavlag U.S,; <br /> W 17.TransporterAcknow4odgmentofRemloarfMaladals <br /> rW Transporter 1 PdnledJt'yped Name Signature Month Day Year <br /> a i � / <br /> Transporter 2 PdntedlTyped Now � Signa no Month Day Year <br /> O Z/ <br /> 16.Discrepancy ff--tt <br /> 18a.Discrepancy Indication Space quantity Type ElResldue L_1 P9r8al Rojection ❑Full ReI,,W,, <br /> Manifest Reference Number. <br /> 18b.Altemale Fadlity(or Generator) U,S.EIIAID Number <br /> Facillty'sPhane: <br /> 10 18c.Signature ofAltamato Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(I.&,codes for hazardous waste treatment,disposal,and recycling systems) <br /> © 1. 4A� <br /> 20,Designated FWlityOwnoror0perator Certincaton of recelp of hazardous materials covered by the manifoslexcep A nded In item 189 <br /> Print 17ype Name SignatureNOn a Your <br /> EPA Form 8701}22(fRev.12-tt P lots a , orts ere o olete. DESIGNATED F 6TY <br /> TO EPA's e-MANIFEST SYSTEM <br />