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f P1else prial or type. I I I I II III �I Form Approved.OMB"0.2050.0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 at 3.Emergency Response Phone A.Man[fest Tracking Number WASTE MANIFEST C A R 0 0 0 2 6 6 2 4 7 a= 87 sib-OOe7 0 01523228 CIES 5.Generatoes Name and Mailing Address Generator's Site Address(if different than mailing address) YULIMSA GALVAN F13f3 S8 OROUND SAME 5655 HOOD WAY I TRACY,CA 95377-7217 ; Generator's Phone: 209 8VL7VQ 5,Transporter 1 Company Name U.S.EPA ID Number VEOLIA 6S 4E93IIMQCAL SOI.C3P CM N I D D f3 0 6 3 1 ' i3 6 9 7.Trans o r2 Compan Name „ U.S,EPA ID Number IlI� L . G 7 3,Designated Facility Name and Site Address U.S.EPA IO Number VBOUAlES TIMIMCAL SOLUTIONS HIGHWAY 73 33 MILE'S W.OF TAYLOR'S BAYOU Fac€li s Phone: PORT ARTHUR,TX 7 T X D 0 0 0 9 3 6 9 6 ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Cla s,ID Number, 10,Containers 11.Total 12.unt 13,Waste Codes I HM and Packing Group Of any)) No. Type Quantity WtNoi. o I' (gIdOI&RCRA HAZARDOUS WAM LIQEM), CONS, 331 4 D M 1 0 1 E P M492 9H w 2. I C) I 3. 4 r t 4- I r 34.Special Handling Instructions aadAdditionallnfomtation I l Wt Setvbce Costed by VHSTS Caahaet u4ainsd by Senealtm confiirs etShotCiry on initial b uspo oer to aM W�a*Know Uwopwem aa►giertaralar's tretAM -E I)W.71529 A: t �I529 r i i 15. GENERATOR'SIOFFEROR'S CERTIFICATIONr I hereby declare that the loonlents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledlplacerded,and are in all respects In proper condlllon for lranspott according to appkable International and national governmental regulations.If export shipment and I am the dmary Exporter,I cerdly that the contents of this consignment conform to the termst of the attached EPAAcknowledgmeni of Consent. I certify that the waste minimization statement Identified In 4D CFR 2&2.27{'a)(it I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generar'sl0fferoe Printedf[ypedNamer Sig a1 Month ,nay Year V 16,International Shipments ❑import to U.S. ❑Export from us. Port of entrylexit: 1 ? Transporter signature(for exports only): Date leaving U.S.; OZ V.TransporietAcknowledgmenl of Receipt of Materials ! l Transporter 1 PrintWyped Name i Signawfe +' Month Day Year a 1011 SILAS III I i �� 1 1 1 712 0 Transporter 2 PrinteOVed NameAll, Signal a Month Day Year I f1� FU2,619al 18.Discrepancy I , I 18a.Discrepancy Indication Space ❑ ❑ } Quantity ❑Type ❑Residue ❑Partial Rejeclion Fa Rejection f Manifest Reference Number: 18b.Aftemale Facility(orGeneralor) U.S.EPA 1D Number a Facility's Phone: H18c.Signature ofAlternate Facility(of Generator) I » I Month JDay Year 19.Hs dous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling syste ) 1. 2. ( 3. 4. ! v i 2&Designated Facility Owner or Opemlor:Certification of receipt of hazardous ateriafs covered by the manlf xcepl as noted In Item Ills i YP lu onth 'D ar EPA Form 8700.22(Rev,f2.17) Previous edilions are ftolale, DESIGN FAC ITY TO EPA's e-MANIFEST SYSTEM