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Please RrInt(;type. Form Approved,OMB No,2050.0039 E� UNIFORM HAZARDOUS 1,Generator ID Number 2.page i of 3.Emergency Response Phone 1' 001801457 11anHeat Tracking Number WASTE MANIFEST C A H 0 0 0 2 6 6 2 4 7 VES i 5.Generators Name and Mailing Address Y1JI139A(2ALVAN Generator's Site Address fachIferent than mailing address) FED EX GROUND SAME 55 HOOD WAY f nerewr'sne95377.7217 e.Transporter 1 Company Name U.S.EPA ID Number IJA RS TBCMOCAL 501.1170M INrD09063 1 369 7.Transporter 2 Company Name U•S.EPA 10 Number 8.Designated Facthy Name and She Address U.S.EPA ID Number VE011h ES TECIDWAL SCWMNS, LLC. 1125 EMMLEY STREET Facilily(s Phone: dqjfl jq3JMI RI2IdOND:CA 9481)1 IC A T 0 8 0 0 1 4 0 7 9 ga, 8b.U.S.DOT Description(Including proper Shipping Name,Hazard Class,ID Number, 10.Containers tit I.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity WWoI. i o ' NON-RCRA HAZARDOUS WASTE LiQUD,MM FAINT, 331 F- OIL) 1 D F 280 P z 2. w 3, 4. I e 14.Special Handling Instructions and Additional information ER.Swvm ConWAld by VMTS + CO2UW MWOW by 6001W oonSats 15 m in1t1a1 to add a WbeotEls addlWa;t1�1 tra�poebrss m bah�lf. -E 1 W.71529 A 15. GENERATORVOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassi sod,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemabona€and national govemmentai reghilafions.If export shipment and I am the Prknary Exporter.I certify that the contorts of this consignment confarm to the leans of the attached EPA A.cknwiladgment of Consent. ( I certify that the waste minimization statement identified in 40 CFR 282.27(a)(ii I am a large quanlily generator)of(b)(•IfI am a smati quantity gonerafor)is true. J GeneratoeslOfferor's Printadltyped Name Signalu Month Day Year LORRAM ORTA 10 3 12 3 1 18.international Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit z Transporter signature(for exports only): Date leaving U.S.: W 17.TransporterAcknoM*rnent of Receipt of Materials LU 12 Transporter 1 PrfnladlTyped Name Signature Month Day Year a 901W CRUZ 10 3 12 3 1 Transporter 2 PrinledlTyped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy indication Space ❑ Qu.thy ❑Type ❑Residue ❑Partial Rejection ❑Full Refection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J i V Facility's Phone: w 18c•Signature of Ahemale Fatality(or Generator) Month Day Year 19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposa€,and recycling systems) 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as nded In Item 18a PrinledlTyped Name Signature ' Month Day ZI Anef uta /�--`_"�� l d3 30 EPA Form 8700-22(Rev.12.17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM