Laserfiche WebLink
lease riot or . MMIN1111 ForM Approved.OMB No.2050-0039 <br /> p <br /> UNIFORM HAZARDOUS 1•Generator ID Number :::112 <br /> Pape 1 of 3.Emergency Response Phone 4,O'Ot������ ��� <br /> WA8TE MANIFEST C A R 0 0 0 7 b d 7 4 7 818-© 87 <br /> 5.Ganeratar's Name and MdINMdreas YULISSA GALVAN Goneralar's SNamm"(11 Warm than muwlg eddresa) <br /> ED EX GROUND SAME <br /> 655 HOOD WAY <br /> TRACY,CA 95377.7717 <br /> Genasalor s Phone: '109 Ainjif'o <br /> 8,Transporter t Company Nems U.S.EPAID Number <br /> GLIA ES TECHNICAL SOLUTIONS N I D 0 8 0 <br /> 7,Traruporter 2 Company Name U.S,EPA ID Number <br /> TRISTATIE MOTOR TRANSIT CO. M 0 D 0 9 5 0 3 8 9 9 8 <br /> 8.Designated Fadlily.Name and Site AddresU.S.MAID Number <br /> FOLIA E5 TECHNICAL SOLUTIONS, <br /> L L.C. <br /> 1704 W.FIRST STREET <br /> Fadb $Pune: 626 334.5117 AZUSA, CA 91707 C A D 0 A 9 3 0 2 0 0 3 <br /> 9a. 9b.U.S.DOT Des*flon("df*Proper SNOW Name,Hazard Claes,10 Number, 10.Cantslnera 11.Told 12.UrA 13.waste Codes <br /> HM and Paddn9 Y)} No. Type Quantity wuw. <br /> F 1 AOHOL,ETHANOL; 3�11LRQ1V01S•m,a.s,, D001 <br /> 1 D F 1 7 3 P 331 <br /> z 2. UN 3 ASTE PAINT RELATED MATERIAL INCLUDING R03 D001 331 <br /> Uj X PAI T INNING, <br /> RDRYING, REMOVING,OR REDUCINGCOMD F 3 02 P F(105 D035 <br /> X 3.1INI 170,WASTE ETHANOL,3,11 D001 <br /> 1 CF 78 F 331 ' <br /> i <br /> X 4 9 CALCIUMCHLORITE,HYDRATED, D001 <br /> IT H Nb LESS THAN 5.5%BUT NOT MORE THAN ld% <br /> WATER,5.1,It.RQ I D F 7 d P 181 <br /> 14.$pedal HandIng Inshdim and Add9wl Intomuativn ER,Service Contracted by VESTS + Contract retained by enerator confers <br /> agency autlzori on initial trosporter to add or substitute addi#ional trim, otters an em razor's b�+II ERO.128 1501 A <br /> 7lS�IA�PKSIUIRG-128W:204261ARCI-90945-097 3 B1�t0:127W. 15l1AAZ 3 PACS 4 �r:140W: <br /> ACK <br /> 15. GENERATrNt'SIOfFEROR`S CERTIt=1CATir)N:E herebl+declare tI►at Ore tomenta a{this mmsipmaent are to�and aoprretdy daedtbed abo's•hY t�►rop�•�1Wto8 and are deeaiAad,packaged, <br /> marked and iabeleNplacarded,and are In all respects In proper condition for transportacoadN to appicable Inlemabomdand rkabond govemm W Madame.If export shipment and I am the Primary <br /> Exporter,I ce"that the comtanta of w a.oonafgrmnt oomkrm to Hie teams of Uw abaeW EPAAdmowl*ment of Consent <br /> I cermy thai the waste miniftiboon statement fdenb8ed in 40 CFR 28227(a)(H i am a Iarpa ganbly generator)or(b)(if f am a small gaanbly PnemM Is true.. aaavvv <br /> Genera elOflaror's I'MkINyped Now Dz <br /> _j 18.Intemabanal ShOmft ❑tmporl to U.S. E]Evw front U.S. Port of entrylexA: <br /> Transporter signature(for expkxts only): <br /> Date leaving U.S.: <br /> 9 17,Tranapa WA*M1e*WI:Of Reoaiptof WWI* <br /> T r 1 Printadlr <br /> S Ya <br /> A <br /> N <br /> Trim 1511: <br /> 1 -" Y <br /> 18. cy <br /> 18a.Discrepancy fndicatlon Space ❑ Quantity Type ❑ ❑Nadid Rod w, ❑R A Rejection <br /> Mamifesi Reterertce Akurrbar. <br /> 18b,Altemate Faclrty(or Generatot) U,S.EqA ID Number <br /> I <br /> U <br /> FadNlye Phone, 14brrttr Day Year <br /> w 18c.Signature of A€tamato Fa ft(or Generator) <br /> a <br /> z <br /> 19.H la Repor4 fdanagemtami Methad Codas Q.a„Codes for hazardous weals treatmank dlepktsd,and racycAng ayeterne) <br /> C 1, M I 2. 3• L <br /> HN <br /> 20,Deslgnalad Fadlity Ovmeror Operator Cerbflcatbn of receipt of hazardous maladals covered by he manlfed cept Nam 1 Bay <br /> Nn/TNnV/T&d Name IT <br /> r <br /> EPA F 7 22 .12-17} Prilvious edillons are obsolete. DESIGNATED FACILITY TO EPA's e•MANIFEST SYSTEM <br />