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I � '!!i!!�illiillll�Illllliilil�iillilll �� a� "Please print or type. i Form Approved,OMB No.2050-0038 UNIFORM 1iAXARDt)US 1.Generator 10 Number t 2.Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Number { �+ WASTE MANIFEST CAROOO 2 6 6 2 4 7 1 {87 8190087 1 5 23338 Y E�7 5,Generator's Name and Mailing Address Y1)LI98A QALVAN Gonerators Site Address(if different than mailing address) F#3D FIX GROUND SAME '. 5655 HOOD WAY - t TRACY,CA 95377-7217 Generators Phone: 209 830-2569 6.Transporter 1 Company Name I U.S.EPA ID Number VEOLIA ES TECEIMCAL SOLUTIQNS I N I D U 6 0 6 3 1 3 d 9 t 7.T sporter 2 Com any Name I U.S.EPA ID b r { 8.Designated Facility Name and Site Address U.S.EPA 0 Number VE LIA ES'TEC9 INCA4,SOLXMONS I HIGHWAY 73 3.5� Y3F TA ,C}R'S BAYOU TOR T 7T X D 0 0 0 9 3 8 $ 9 6 Facilityls Phone: X409 736-2821 9a. gb.U.S.DOT Description(Including Proper Shipping Name,Hazard Cla s,ID Number, 10.Containers 11.Totat 12.Unit 13,Waste Codes HM and Packing Group(if any)) No. Type Quantity WI.Nol. 1 N014-RMA SUS WASTE LIQUID,{LA�M PAINT, 331 OIL) 2 DM 333 F OU829H Z 2. LUiC7 3. I I I 4. I. f 14.Sp�edgaeiHandling InsWclonsand AddittonalInformation ER Service CwhadedbyVESTS + Ca*adreteinedby ntrdwcanfers `PA0715atiaitialttanapcxterOaacWarttlGttleasWifaanaltre�sporl+etsangeaeralo�sbahel� -h29 W:7i579A, i 15. GENERATOR'SfOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledfplacarded,and are In all respects In proper condition fdr transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the term of the allarhad EPAAcknowledgment of Consent. I certify that the waste minimization statement Identified In 40 CFR 20227(a)(if I am a large quantity,generator)or(b)(If I am a small quantity generator)Is true, t General rq s1OHerors PdntedtTyped Name Si nate Month Day Year 1 ,J %Yte, d 110 5 12 1 16,Inlematonal Shipmentsp ❑Import to U.S. ❑Export from U.S. Port of enlrylexit.• Z Transporter signature(for exports only): Date leaving U.S,; W 17.TranspoderAcknowledgmenlofReceiplofMatedals LU Transporter 1 PrintedfTyped Name Signature Month Day Year IOEL SILAS M ' JI 10. 1 10 s 12 1 Z Transporter 2Printed(Typed S nature Month Day Year 18.Discrepancy 18a.Discrepancy Indtcation Space El quantity F1 Type ❑Residue ❑Parvai Roeetlon } ❑Fut(Re ection Manifest Reference Number: 18b,Alternate Facility(or Generator) U.S.EPA ID Number J U ' LL Facilillfs Phone: W 18C.Signature ofAltemateFacility(or Generator) Month Day Year Q US19.Hazarjous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) Q 1. 2. 3. 4. a 20.Designated Facility Owner or Operator:Certification of receipt of haze us materials covered by the Tinifestexopt as nded in Item lb doled y a M D y ear r EPA Farm 87))0- 2 ev. - revio editions of s $DGN ATED FACllwl TQ A's e•M NIFEST SYSTEM