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1I <br /> Please print or VIII II IIII11Ilu II FonAppFoved.Oh t3 Irl . 50-0036 <br /> UNIFORM HAZARDOUS 1•Generator ID Number 2.Page 1 of 3.Emergancy Response Phone d.Manliest Tracking umher, e <br /> WASTE MANIFEST 9 ' VES <br /> 6.Generator's Name and MailingAddtess YULISSA i3ALVA13 Generaldes S€toAddtess(If different than malling address) <br /> FBI)EX GROUND SAME <br /> 5555 HOOD WAY I <br /> ' RA <br /> oTjP 95377-7217 <br /> p 8304560 <br /> snare o s QA: <br /> one <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> VEOLIA ES TECHNICAL SOLUTIONS <br /> 7,Transporter 2 Company Names, U,6.EPA tO Number i <br /> `{• ,C1 <br /> HIGHWAY73$. <br /> Designated FadI4 Name and Site Address 1111 1 U.S.EPA ID Number <br /> VEOLIA ES TECHNICAL SOLUTIONS i It <br /> I , <br /> 3.5 MILES W,OF TAYLOR'S BAYOU ' I <br /> Facl1 s Phone: PORT ARTHUR,TX 77640 <br /> go. gb.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Conlainew 1t,Total 12,Unit 13.Wase Codes <br /> HM and PackingGroup(if any)) No. Type Quantity WL/Vol.! <br /> uG X t. 3175,WASTE SOLIDS CONTAINING FLAMMABLE F0 3 Al <br /> .0 f 1QUID,n.o.s.,(DEBRIS CONTAMINATED WITH I <br /> SOLVENTS).4.1,Il 1 D F 4 5 P D061 0+T90911 f <br /> 2. OILS-RCRA HAZARDOUS WASTE LIQUID. (LATEX PAINT, NONE <br /> 2 D F 374 P 33 06TS7 19H l <br /> 3. ? I <br /> 4, t <br /> i <br /> 14.Special Handiing Irebuctl2oons andAdditlonal Information ER Service Contracted by VESTS + Contract retained by enerator co Pers <br /> A��[]PyiA0D047I5�8 �anspo�er:tto'I`AO 1 r sg6�tute additional t<ar*rters on generator's behalf + IERG:131 y.:715481A: <br /> ' k <br /> I <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the oonlents of This consignment are fully and accurately described above by the proper shipping name,and a classified,packaged, t <br /> marked and labetedlpiacarded,and are In all respects In proper condition(or transport acoord€ng to applicable intemailonaland national governmental regulations.It export shipment and 1 am Ute Primary <br /> Exporter,I certify that the ocntents of this consignment conform to the terms of the attached EPAAckrawledgmenlof Consent. € <br /> I certify that the waste minimization statement Identified In 40 CFR 262.27(a)(If I am a large quantity generator)or(b)(91 am a small quantity generator)Is true, r <br /> GeneratoesloRemesPdntedrrypedName Signature Mon Day Year <br /> 16.Inlemational Shipments <br /> ❑Import to U.S. ❑Export from U.S. Pod of entrylexil: <br /> M Transporter signature(for exports only): Date teaving U.S.: <br /> 17.TrampaterAcknowledgment of Receipt of Materials <br /> tu <br /> T der i Printadlr ame Sig Man Da Year <br /> O <br /> IL <br /> aZ118. <br /> Trans er2PnnledrrypedNam Month Day Year <br /> F I <br /> Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quentity ❑Type ❑Residue Partial Rejection ❑Full Rejection <br /> Manifest Referenoo Number: <br /> 18b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> C7 <br /> FaclliV,5 Phone: <br /> W 18c,Signature ofAllemaleFacility(or Generator) Month Day Year, <br /> Q ' <br /> Z f <br /> 19.Hazardous Waste Reitu Dport Management Method Codes(Is„codes for hazardous waste treatment,disposal,and recycling systems) <br /> � 1. 2. 3. 4. E <br /> I <br /> 20,Designated Facility Owner or Qperator�Certification of receipt of hazardous materials co red by the manifest except as noted In hem 18a <br /> Pdnted/Typed Name Slgnat Month 1Year <br /> i !`J <br /> EPA Form 15700-22(Rev.12-11) Previous editions are obsolete. DESIGNATED EAC ITY TO EPA's&• ANIP ST SYSTE <br />