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IIIIIIIiII�l�llllllilllllllllllll� Please print or type, Form Approved,OMB No.2050-0039 UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phone Man et Tracking Number c WASTE MANIF=EST GAR 0 0 0 2 6 6 2 4 ? 1 (877 $Ia-0087 4. 0 015 2 3 216 VES 5.Generato>s Name and Mailing Address M GALVAN Generators Site Address(if different than mailing address) 1 FED EX 9 1 5655 HOOD WAY TRACY,CA 95377-7217 Generators Phone: 8.Transporter 1 Company Name U.S,EPA 10 Number VWLU®TBCEMOCAL BOGUT[OL'>IB N J D 0 1 0 6 3 1 3 6 9 1.Transporter 2 Company Name U.S.EPAID Number 2-V)- IcRaen 6 I8.Designated Facility Name and Site Address U.S.EPA ID Number 1 I.L.G. 1 r125}lRCLEY BTFd T XXMM0W CA Factfi s Phona: 94101 C A T 0 1 0 0 1 4 0 7 9 ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Gass,10 Number, 10.Contalnors 11.Total 12.Unit 13.Waste Codes HM and Paddng Group(If any)) No. Type Ouanlity Wt.Nol. o x 1' t Wt95r11i,00/MUEOW GAM, (1 ROOK CA22M 181 DKE111211313%12 1 C Y 53 P W 2. 1 1 3. 1 1 4. 1 14.Special Handling Instructions and Additional Information I&Swum sW'CdbmUd by VEM + QNftd[e14=d 1170 wmeitdwCurnElss Yqtoriad�on inI>Yrmpoehr 10&Met m hilar Ra 6dditiol d 4nmpollAn on IoCt 6eaaf - t ERGAX W.933329 LEMMT 15. GENERATOR'SIOFFEROR'5 CERTIFICATION:I hereby declare that tiro contents of this consignment are Iully and accuratelydascrlbed above by the proper shipping name,aid are classified,packaged, marked and labeledfptacarded,and are in all respects In proper condWon for transport according to applicable inleme0onal and national governmental regulations.If export shipment and I am the Primary 1 Exporter,I certify that the contents of this const nment conform to the tans of the attached EPAAdwaMedgment of Consent. I certify that the waste minimization statement identified In 40 CFR 282.27(a)(if I am a large quantity generator)or(b)(if t am a small quantity generator)Is true. Generat erdOfferoes PdnteVypedName Signature Month Day Year 16.International Shipments 1 1 1 7 2 0 i F 1:1 Import to U.S. ❑Export horn u.5. Port of enlrylexit: z Transporter signature(for exports only): Date leaving U.S.: 17.TransporterAduwwledgment of Receipt of Materials Transporter 1 Printedffyped Name Signature �� Month Day Year JOEL SI "M R �'�V 1 11 1 712 0 Transporter 2 Printadl�y�1 Name Sign Month Day Year r- t/p 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number U Facility's Phone: 18c,Signature DfAitemate Facility(or Generator) Month Day Year d Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatmenl,disposal,and recycling systems) UJI 1. f,/ 2. 20,Designated Faeltlty Owner or Operator:Certification of roceipl of hazardous materials covered by the manifest except as nded in Item 18a Pdntedff Name Signature Month Day Year FPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e•MANIFE$T SYSTEM 1