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el ase print or type. Farm roved.OMB No.2050-039 <br /> TENIFORM HAZARDOUS1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number iCC t <br /> WASTE MANIFEST6 6 001793 Y G <br /> 5,Generalor's Name and MellingAddress YCILI$BA 4ALVAN Generator's SiteAddresa <br /> (tl different than mailing address) <br /> FED <br /> EX GROUM SANT <br /> 655 HOOD WAY <br /> GItA{''trsCphA 95377-7217 <br /> 2 830-2560 <br /> B.Transporter i Company Neme U.S.EPA ID Number <br /> N r 1) 0 8 0 6 3 1 3 6 <br /> 7.Tra porter 2 rany Nam U.S.E A I umbos 't /} <br /> �--,). t <br /> 00 <br /> T Deslgnal Fad ty Namo and iia Address U.S,EPAID Number [[1 L <br /> VEOU A U TRCHI1UCAL SOLIMONS <br /> MORWAY 7.3 <br /> 3,5 unss w.OF TAYLCIR'B BAYOU <br /> Facili s Phone: PORT ARTMIX TX 77640 IT X D 0 0 0 8 3 6 8. 51 i <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Norm,Hazard Class,ID Number, 101.Centelners tt.Total t2,Unit 13.Waste Codas <br /> HM and PadangOmp((dany)) No. Type quantity W111voi. j <br /> ad 1. N0I4-RCRA RALARDOUB WASTE LIQUID,(6ATEK PAINT, 331 <br /> OEL) <br /> 3 D M 6 5 3 P OUT82198 <br /> 2, <br /> W <br /> O <br /> 3. <br /> 4. f, <br /> 14.Special Handling Instructions andAddlliona!informalian <br /> ffit Sezwire Cadacted by V813T8 + Cau6met mkaiztad by senewow cocderr <br /> Of <br /> at a5utority oto ito-itiat U&MWWr too add or taubstiGs6e ru�ittnrtat�m vat gsnaxahat's behalf -1:1j W.71529 A: <br /> P A0 Isz <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the propershipping name,end are classlfled,packag } <br /> marked and labeledlplacarded,and arc In all respects in proper condition for transport according to applicable international and national governmental regulations.if export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAckmwladgrnentof Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(#I am a largo quantity generator)or(b)(ill am a small quantity generator}Is e. <br /> Ge neretor'sfOfferors Prins fTypW Name Signature Month Day Year <br /> UlSSS LV10 nz#= In 3 t <br /> 16.International Shipments ❑import to U.S. ❑Export from U.S. Port of enbylexit: <br /> Transpoderslgnature(for exports only): Data leaving U.S.: <br /> W 17.TransporlerAdmuwlsdgmont of Receipt of Materials E <br /> iXTransporter 1 Prinledlfyped Name Signature Month Day I Year <br /> O /j 1 <br /> a <br /> Tnansportork Prin yp Name 5'n�lura Month ay ear <br /> 16,Discrepancy <br /> 18a.Discrepancy Indkatbn Space ❑ quantity ❑Type ❑Residue ❑Partial Rejection ❑full Reject on <br /> Manifest Reference Number. <br /> 184.Alternate Facility(or Generator) U.S.EPAiD Number <br /> U <br /> Facility's Phone: <br /> w 18c,Signature of Alternate Facility(or Generate() Month Day Year <br /> C9 19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste beelmonl,disposal,and recycling systems) <br /> 0 2. 3. T7- <br /> 2Q. slgnated Facility Owner or Operator.Certification of receipt of hazordoos materials covered by the manifest a cepi as nded in Item 188 <br /> Pinto Name rra 1h y I Year <br /> CV <br /> EPA Form 8700.22(Rev.12-17) Previous editions areobsolete, DESIGNATED FACILITY TO EPA's e-MANIFEST S TEM <br />