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Please print or type, FormApproved,OMB No.2050-0039 ' <br /> f UNIFORM HAZARDOUS t.Ganeralor ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C A R 0 O'A 2 6 6 2 4 7 &iJ?I•i1067 001796187 VES <br /> 5.Generators Name and Mailing Address YULX6#A 0ALVAN Generators SIIeAddress(it different than malting address) <br /> FW 8R(MUM <br /> Ess B> �yWAT <br /> TRACY,CA 9M-7217 <br /> -7217 <br /> Generators phone: <br /> 6.Transporter l Company Name U.S.EPA 10 Number <br /> 7.Transporter2 Company Name U.S.EPA 10 thimbet <br /> t✓ <br /> B.Designated Facility Name and Site Address U.S.EPA ID Number <br /> VBOLIAHS THCHNWIALSOLUIUMN <br /> 19mt331�(4�A�r� <br /> 3.5)ffi!39 W.(W TATLOW9 BATT <br /> Facilitys Phone: FCxT T X 13 0 8 Q A 3 a 8 9 4 <br /> 9a, 0b,U.S.DOT Descxiptkn(including Proper Shipping Name,Hazard Class,ID Number, to,Containers 11.Total 12.Unit 13,Waste Codas <br /> HM and Packing Group(if any)) <br /> No. Type Quantity WINoI. <br /> 1' <br /> NON-=A <br /> -Ram HIILLMOM WMIN UQ=U AiTIL PAINT, 331 <br /> D m 9 3 5 F UUMIM <br /> 2 2. <br /> LU ' <br /> C7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional information <br /> Y� 1 tm t G11 C0 (MW& + 1)V�. A: <br /> r <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classlRed,packaged, <br /> marked and labeladTplacarded,and are In all respects in proper condition for transpofl according to applicable intern0ona€and national governmental Agulattons.If export shipment and I am the Primary <br /> Eirporter,I carti fy that the contents of This consignment conform to the terms of the attached EPAAcknowledgmenlof Consent. F <br /> true-I certify that the waste minimization statement Identified in 40 CFR 262.27(a){if I am a large quantity generator)or(b)(If t am a small quantity generator)is <br /> tors/Offerors PrintadTryped Name n ' Signature Month Day Year <br /> 1V 0 5 R 4 3. <br /> 16.International Shipments <br /> A� <br /> ❑Impart to U.S. ❑Export from U. . Port of enlrylexit: <br /> Transporter signature(for exports only); Date leaving U.S.: <br /> Ce LU <br /> 17.TransportarAcknowledgment of Receipt of Materials <br /> Transporter 1 PrintedTTyped Name Signature /J Month Day Year <br /> a tC=WAS ffi � •��X` l d S 10'4 f <br /> Tra po ntedlT d N md lure Month Day Year <br /> 16.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity' El Type ❑ReMdve ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number; f <br /> 18b.Alternate Facility(orGeneralor) U.S,EPA ID Number <br /> U I Ej <br /> uQ- FacAlyrs Phone: ; <br /> W 16c,Signature of Alternate Faculty(or Generator) Month Day Year <br /> a - <br /> a <br /> ra 19.qazajdow Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1. <br /> 20,Designated Facility Owner or Operat • rligoadon of receipt of hazardous materials covered by the manifest a pl as acted in Item 18a <br /> erne w S 116 <br /> YI <br /> EPA Form 8T00-22(Rev.12-17) Previous a it(ons are bsolete. pESIGNA 'ED FA ILITY TO EPA's&MANIFESTSSYSTEM <br />