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--Please printor type. form Approved.OMB No,2050.0039 UNIFORM HA7ARp0US 1 Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAR 0 0 0 2 6 6 2 4 7 1 a 811t1.00s7 0 015 2 3 3 3 9 VES 5.Generator's Name and Mailing Address YULIM OALVAN Generator's SiteAddress(if different than mailing address) FW EX OROUND SAUL 5655 HOOD WAY TRACY,CA 95377-7217 GeneretoPs Phone• 209 A?MSM 6.Transporter 1 Company Name U.S.EPA ID Number VEOLIA 8S TSCH111`4CYAL W%UTTONB IN I D 0 8 0 6 3, 1 3 6 9 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address VUS.EPA ID Number ta�wpliA EX�C.,AL>801.i1I7S1I�� L,L,C. 1125 BEhIRM STIOW Facillty's Phone; RIs,CA %Wl C A T 0 8 0 0 1 4 0 7 9 ga. 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13,Waste Codes HM and Packing Group(If any)) No. Type Quantity Wl.Nol, o X 1, U+11016,WARrE CtARSCedM NQXMOR CUWRUMSD,Z3 DOW t2.t) 2 G Y 2 P 331 LU 2. uu c7 3. 4. 14.5peGal Handling Instructions endAddilional Information ElIt Smwe Ccdmth4 by VEM + Cmilkiiiell.[e'flmd com(k7 @@"96 tllho y an eaifi�t>eut�paet6�e t3o t�1d ar su�ti�ule radisianri><.�ata�a aQ gAtoeettoe�a b41�IL + 1 ERCt:119 w;st9611 A: 15. G£NERATOR'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 labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that Ste contents of this consignment conform to IN terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quanlilygenerator)or(b)(if I am a small quantity generator)Is we. GeneralceslOfferor's PrirtedlTyped Name sign re Month Day Year 16.International Shipments ALL 9?jfJA 10 1 In 112 1 ❑Import to U.S. ❑Export from U.S. Port of ontryloxit: Transporter signature(for exports only): Date leaving U.S.: W me 17.TransporterAd norwiedgnt of Reeatptof Maleriafs Uj Transporter 1 PdnledlTyped Name Signature Month Day Year as r 9 110 5 12 1 Transporter 2 PrtnledlTyped Name S g re Month Day Year t- 1 a.Discrepancy 18a.Discrepancy indication Space ❑quantity ❑Type ❑Residue ❑Paritaf Re)ecdnm ❑Full Rajed.n Manifest Referenoe Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number V LL Facilityls Phone: 180.Signalure of Allemale Facility(or Generator) Month Day Year y19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) © 1 1,1/ 2. 3. 4. 20,Designated Facility Owner or Operator:Certifieallm of receipt of hazardous maledafs covered by the manifest except as noted in Item 16a Printedlfyped Nam L Signature Month Day Year lee EPA Form 8700.22(Rev.12.17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e•MANIFEST SYSTEM