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-tease print or type. 11111021111110 Form Approved.OMS No.2050.0039 <br /> UNIFORM HAZARDOUS t Generator ID Number2,Page 1 of 3.Emergency Response Phone 4,ManHesl Tracking Number VES WASTE MANIFEST C A 11. 0 0 0 2 6 6 3 4 7 0 017 9 3 2 9 1F EV <br /> 5.Generatars Name and Mailing AddressYUL199A LVAN <br /> Generators Site Address(if different than mailing address) <br /> FED MC(HICK N17 SAKE <br /> S655 HDD WAY <br /> �eec�r 95377-7x17 <br /> Generators PMne: <br /> 6.Transporter 1 Company N,no 8=50 U.S.EPA ID Number <br /> YR ARSTRIUM4VALBOLVISM <br /> N J D 0 $ 0 6 3 1 3 6 9 <br /> 7.Transporter 2 Company Name U.S.EPA IA Number <br /> B.Designated Facility Name and She Address U.S.EPA ID Number <br /> VOOLIA 135 TBCH W.AL.SOI3J1YJW <br /> L.I.C. <br /> 1125 HM49LEY S7811J31' <br /> Faali{ys Phone: R��,CA 9�D1 CAT 0 80 0 1 4 0 7 <br /> ge, 9b.U.S,DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unll <br /> HM and Pac13.Waste Codas <br /> king Group(g any)) No, Type Quantity WtNat. <br /> a 1' Na"CRAHA7J11tDp1)f3 WAIM LQI1m,(L,A'181C PAINT' NUM <br /> OIL) <br /> lid 1 D F 140 P 331 <br /> z 2. <br /> w <br /> tti <br /> 3. <br /> 4, <br /> 14.Special Handling Instructions and Additional Information 111 rQMi=C=t>W by,RM + COIF S <br /> Ott a h&W'—p-i-in add a Abath tae o6eflai�o rim eta�altlllrlr btu -� 1 W-71529 A: <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that ft contents of this consignment are fully and accurately described above by the proper shipping name,and are classified.packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable International and national govemmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the conlants of this consignment omfomi to the law of the a(tached EPAAcknowledgmentaf Consent. <br /> I oar*that the waste minimization statement Identified In 40 CFR 262.27(a)(H 1 am a large quantity generator)or(b)(If I am a smell quantity generator)is true. <br /> GeneratorslOfferoes PrintedtTyped Normo Sgnafure Month Day Year <br /> LZIRRADIE ORTAIt 2 11 3 <br /> 16.international Shipments <br /> ❑import to U.S. ❑Export from U.S. Port of entrylmdl: <br /> ? Transporter signature(for experts only): Date leaving U.S.: <br /> W I T.Transporter Acknowledgment of Receipt of Materials <br /> LLJ <br /> tz Transporter 1 Printed/Typed Name Signature Month Day Year <br /> a SONNY CRW 1 2 11 3 0 <br /> Transporter 2 Printed/Typed Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indiradon Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑m Rejection <br /> Manifest Reference Number. <br /> 18b.AHemate Facility(or Generator) U.S.EPA to Number <br /> U <br /> w Facilitys Phone; <br /> LL, 18c.Signature ofAtemale Facility(orGeneralor) Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste ReM Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems} <br /> � 11 P/� r 2, T. <br /> 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materiels covered by the manliest except as nded in Item 18a <br /> PrIntyTypecl NSignature Month Day Year <br /> EPA Farm 8704-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />