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Gma Please print or type. 0GENERATOR ed.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1 1,Generator I Ngo3g8 1 of 3.Emergency Response Phone 4.Manifest Tracking r <br /> WASTE MANIFEST C A R 0 0 0 2 6 b 2 d ? I 1 87 SIM87 001523436 3 VES <br /> 5,Genemtor'sNam and Mailing Address YULISSAOALVAN GenaratorsSHO Address(•ddltlerentthan mailing address) <br /> FFD EX GROUND 8AM6 <br /> 5655 HOOD WAY <br /> TRACY,CA 43377-717 <br /> Generator's Phone: g <br /> 6.Transporter 1 Company Neste U.S.EPA ID Number <br /> VEOLIA ES T&URMCAL SQL[Fi OM N ] Y7 O 8 0 d 3 1 3 6 4 <br /> 7.TranspnNer 2 Company Name U. .EPA D Num <br /> rAnd <br /> 8.Designated Fadifty Name and She ddress U.S,EPA t Number <br /> VEOLLA ES 7ECHC4C gQLtMONS <br /> 7 MOBIM AVRRM <br /> SAU(W,IL 62201-1 <br /> FadlitysPhone: 618 2712804 I i ], ) 0 9 8 6 4 2 4 2 4 <br /> ga, ,gb.U.S.DOT Description(Including PrroperSNpping Name,Heard C s,ID Number, 10,Containers 11.Total 12.Unit <br /> HM and Packing Group(g any)) No, Type Quantity WtJlrol, 13.Waste Codes <br /> 1. <br /> K <br /> X 2. 1L19ND044,WA=PgtII�E Si f`AF�"1'PrFi.r�i3I2Q0 �0317�. � D003 I3003 331 <br /> v 1 C F 12 P D001 D008 <br /> X 3, NA3178,WA9M StrB)KE10M POWDER FO1t MALL ARMS D003 <br /> OOD FOUNDS OR LESS(pC, OQJ0137X 4.1,]; <br /> S�I 1 G F 9 A 331 <br /> 4. <br /> E <br /> 14.Special Handling instructions and Additional information 1IR Bert <br /> ICC CO*Rdilld b9 VEM + CmiftCt tetkiwd by oeratm confem <br /> 5�9111�U[ OIQ U tl119�tClt tIp R�Of 1�qp 0el�yg qp UQt Q°S + <br /> � 1� 2)W*'E 41154 A. 91154 N.SW.�0.03 9MM&K W-4)50317 9)MWA 33 W: <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:t herebydedare that the tents of this consignment are fully and aaxrratolydesorlbed above by the propershippN name,and are classified,packaged, <br /> marked and labefedlplacWad,and are In all respects in proper conditkn F transportaccording to appfcable Intem lional and naliona€govammentel regulations,It export shlpmanl and I am the Primary <br /> Exporter,I certify[hat the wntents of this consignment conform W the tormof the attached EPAAcknawl dgmenl of Consent <br /> 1 certify that the waste minimization statement identified in 40 CFR 262,27(a)(If I am a large quantity generator)or(b)('d I am a small quantity generator)Is true. <br /> G eralor slCNferor s Pdnfedlfyped Meme S' Ina Month Day Year <br /> VYtil l U G C�21�.�0 0 1 1 2 1 <br /> 16,Inlemat ena€Shipments <br /> i-- ❑Impart to U.S. ❑Expod from U.S. Port of entrylexil: <br /> 2 Transporter signature(for exports only): Date leaving U.S.: <br /> 17.TransporterAcknowtodgment of Receipt of Materials <br /> OTransporter 1 Pdnladr7yped Name Signature Month Day Year <br /> a JOFL 81T.Af#III O � o f 1; Z 12 1 <br /> z Transporter Pdnleel fypod Name Slgnalu <br /> Month pay Year <br /> csuc--r* <br /> 18.Discrepancy 1 3— <br /> Lu <br /> 18a,Discrepancy Indication SpaceElquantity <br /> Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 18b.Allemate Facility(or Generator) Manifest Reference Number, <br /> =r U.S.EPA ID Number <br /> Facility's Phone: <br /> 18c.Signature ofAllemate Facility(or Genaraforj <br /> Q Manch Day Year <br /> z <br /> LULU <br /> 19,Hazardous Waste Report Management Method Codes(i.a.,Codes for hazardous Meta treatment,disposal,and recycling systems) <br /> Q 1 2. <br /> H040 3. H040 4. <br /> 7 I <br /> P nledlryped Name <br /> 20.Designated Fadfity Owner or Operator:Certifloatkxt of receipt of hazardous materials covered by tiro manffast except as nded in gam fife <br /> VSig a re Month Day ear <br /> EPA Form 8700-22(Rev.12-17) Previous edifions are obsolete. 3 I ; <br /> DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />