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€ <br /> 11111111111 IN 11111 <br /> Please print or type. Form p oved.OMBo-.2050-0( S <br /> UNIFORM HAZARDOUS1.Generator ED Number f 2.Page 1 nt 3,Emergency Response Phone T001523244 <br /> Manifest Tracking Number <br /> WASTE MANIFEST C A R 0 0 0 2 6 6 2 a 7 1 (877)818-008? ES <br /> 5.Generalars Name and Mailing Address Yumsm aALvA1•T I Goneratoes Site Address(if different than mailing address) <br /> FED RX QR0t= # SAME 1 i <br /> 5655 HOOD WAY <br /> TRACY,CA 95377-7217 { <br /> Generalor's Phone: 209 830-2569 <br /> 6,Transporter 1 Company Name U.S.EPA ID Number <br /> , <br /> VEOLTA 59 TECTINrCAL SOLUTIOM N I D 0 B 0 6.3 1 3 6 9 ' <br /> 7.Transporter 2 Company Name U,S. IDN ether <br /> bcM <br /> 8.Designated Facility Name and Site AddressVEC1JA ES TRCHMQp L SOLVnC S U.S.EPA ID Number <br /> I <br /> HIGHWAY 73 i f <br /> 3.5 MMM W.OF TAYIAR'8 BAYOU <br /> Facili 's Phoma: 409 73b-2821 PORT ARTHUR'TX 77640 T X D 0 0 0 8 3 8 8 96 <br /> ga 9b.U.S.DOT Description(inciuding Proper Shipping Name,Hazard Class,ID Number, 10.Conlainom 11,Total 12.Unit <br /> and Packing Grou if an Quantity WLIVol. 13.Waste odes <br /> HM 9 P( YI) No. Typo ty <br /> 1. 14MRCRA RA2ARDOM WAST&LIQUID(S LICOMOI 331 1 <br /> O OIL) <br /> 3 DM 786 P OM82 9H �1 <br /> w <br /> 2.Uj <br /> t <br /> t7 <br /> i <br /> 3. <br /> 4- <br /> 14,Special Handling Instructions and Addilional Information ER Skrltke CwbnkWed by VEM + L. }L hitimd by vArdm coufe[s <br /> a�eacy IIt111tfrtltllY a€o initial�anvpaiber W rude otr srtbstisute fllirxtal l�t►vlrotters otu betide I 1W:71529 A: <br /> A071529 ' <br /> 15. GENERATOR'S10FFEROR'S CERTIFICATION; I hereby declare that ft contants of this consignment are fully and accuralely described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlpiacarded,and are in all respects In propercondil'Ion for transport according to applicable international and national governmental regulailons.If export shipment and I am the Primary <br /> Exporter,I certify,that the consents of this consignment comfort to the terms of the ailached EPAAcknowledgmant of Consent. <br /> I certify that the waste minimization statement identified In 40 CFR 282.27(a)(if f am a large quantity generator)or(b)(d l am a small quangly generator)is true. <br /> Genorato�sl0llerotsPdnledifypedName Signatur 4 Month Day Y ar <br /> 1 21 112 <br /> 16.International Shipments <br /> F F—]Import to U.S. ❑Export from U.S. Port of entrylexit: E <br /> ? <br /> Transporter signature(for exports only): Date leavingU,S.; <br /> x 17.TransporterAcknorAedgment of Receipt of MaterialsLu <br /> j f <br /> Transporter 1 PrinledlTypad NamoSignature Month pay Y Ar <br /> JOEL BRAS III 1 2 4 112 IO <br /> Z Transporter tedffypedName Signal Month Day ar <br /> 18.Discrepancy I : I�--� <br /> 18a.Discrepancy Indication Space El Quantity `L1 Type ❑Residue ❑Padiai Rejection ❑Ful Rejection 1 <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> LL FacilitysPhone: <br /> 18c.Signature of Allemale Facility(or Generator) i Month I Day ear <br /> Q ' I <br /> Z <br /> 19.Ha ardous Waste Reporl Management Method Codes(W.,codes for hazer ous waste treatment,disposal,and recycling systems) <br /> LLI <br /> 1, ^ 2, 3. 4. I <br /> V <br /> 20. esignaled Facility Owner or Operator:Certification of receipt of hazardous i manifesl ex t as noted in Item 18a <br /> are- e-- Lc�apnA ! Month Day Y ar <br /> 'IF DW l.z) <br /> EPA Form 8700-22(Rev,1247) Previous edificins ailb obsolete. i DESIGEVA FA IE_ITY TO EPA's e•MANIFEST SYSENE <br /> I <br />