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- 111 911111111111111111111 <br /> P€ease print or type. f=orm Approved,OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2,Page 1 of 9.Emergency Response Phone 4.Manifest Tracking <br /> Numbbere <br /> WASTE MANIFEST C A R 0 0 0 2 6 6 2 4 7 1 (TM 818-0087 001523124 VE V <br /> 5.Generatoes Name and Mailing Address YULMINA GALVAN Generator's Site Address(€f different than mailing address) <br /> 1M WC GR.OLM SAW[Ei <br /> 5655 HOOD WAY <br /> T1tWY,CA 95377-7217 <br /> Generaloes Phone: 2D9 830-2569 <br /> 8.Transporter 1 Company Name U.S,EPA ID Number <br /> VBMIA I38 THMIRCrAL t#Mt]TIt78+16 N ] 1 0 8 0 6 3 1 3 6 9 <br /> 7.Transporter 2 Compf ny Name U.S.EPA ID Number <br /> Cle <br /> 8.Designated Faolliry Name and Site Address�A EN TBMMCAL KXUTIO , U.S.EPAID Number <br /> L-L.C. <br /> 112513FsT+]>M 8'!`RW <br /> Facilitys Phone: 510 2334001 RICHUEM CA 94801 C A 1 0 8 0 0 1 4 0 7 9 <br /> ga, 9b,U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1 luR7INa RA HAz11itD0 A WAsm L[gtm Q•p►'l m PAwr, 331 <br /> �a <br /> OIL) 2 D U 539 P <br /> Z 2. <br /> w <br /> C7 <br /> 3, <br /> 4. <br /> 14,Special Handling Instracttons and Additional information Int.smicE owime d by VEE + cmiti!4 mb"d eons <br /> �15f�04 iAd t�lm�mft Its add cc Parolee addit wal t wgmd�n�ran moor,W& -F 1 W:71529 A. <br /> 15. GENERATOR'SIOFFEROR'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, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to appl€cable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certlly that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(x)(if I am a large quantity generator)or(b)(ifl am a small quantity generator)Is true. <br /> Generalm`s10fleror`s PrintedlTypod Name Signature Month Day Year <br /> YC1Fd88A 4ALV'AN 1 44 1 1 010 612 0 <br /> 15.International Shipments <br /> ❑Import to U.S. ❑Export from U. Pari of entrylexit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.TransporterAcknowlecigment of Receipt of Materials <br /> CW Transporter 1 Printed/Typed Name Signature Month Day Year <br /> lom,sn"M 1 1 0 0 612 0 <br /> Z Transporter 2 PrintedlTypod Name Sign atu Month Day Year <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space El Quantity [EllType ElResidue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number; <br /> f 18b.Alternate Facility(at Generator) U.S.EPA ID Number <br /> J_ <br /> C.7 <br /> f LL Facility's phone: pay Year <br /> 18c.Signature ol'Memate Facility(or Generator) Month <br /> 1 a <br /> 1 � <br /> 19.Hazardous Waste Report Management M80W Codes(i.e.,codes lot hazardous waste treatment,disposal,and recycling systems) <br /> a 1 2. 3, 4, <br /> 20,Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as rated in Item 18a <br /> PrintedlTyped Name Signature 12 Month Day Year <br /> GL— � 110113170 <br /> EPA Fort 8700-22(Rev.12-17) Previous editions are obsolete, DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />