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pWapdn� IMI0 form Approved.OMB No,2060-0438 <br /> ONIFORM WARBOUS 1.Generator ID Number z Pape f of 3.Emergency Response Phone4. Rat T M NUmbw <br /> WASTE MANIFEST IC A R 0 0 0 7 6 6 2 4 7 9 e 8I8•AA87 0 01796 8 VES <br /> b.Generatoea Name and h3allrnp Address Y-tJUSSA GALVAN Gor mlor's SbAddreas(f d'dferent then mailing address) <br /> 5MD 6p HE OOD W Y <br /> TRACY,CA 95377.7217 <br /> Generators Phone: 209 <br /> 8.Transporter 10arpanyNeme - U.S.EPA ID Number <br /> VEOLIA ES TECHNICAL SOLATIONS N J D 0 8 0 6 3 1 3 6 9 <br /> 7.Trerraporler?Company Name U.S.EPA ID Number <br /> TRISTATE MOTOR TRANSIT CO. MOD 0 9 1 0 3 8 9 9 8 <br /> 8.DeetQrtaled FadlKy Normo and SltaAdareaaV$OLIA TECHNICAL SOLATIONS U.S.EPA ID Number <br /> L.L.C. <br /> 1704 W. FIRST STRUT <br /> Fuji ePhone: 676 334-5117 AZUSA,CA 91707 C A D 4 0 8 3 0 2 9 0 3 <br /> 9b,U.B.DOT Description(Including Proper Shlppkv Name,Hazard Clsae,ID Number, 10.Contahete 11.Toter 42.Unit <br /> HM andPaddnp P(lt any)) No. type Qwmt ty MlVol. 19,Warta Codes <br /> a x 1. UN1993W ISTER AMMABOP ,3E LIQUIDS,mo.s.,(ETHYL DDO1 <br /> ALCOHO1 D F 1 18 P 331 <br /> x 2 UN7974(� A-T�`L 41Mlr ILE LI?UIDJ CORROSIVE„ D001 <br /> co n.o.s., ET OL), (8),1 <br /> g g(� g 1 D F 2 6 p 331 <br /> 3 LINJ D'n�o�s..T{pgHR1 C�NTAM1NA ED WITH <br /> f+QA3 357 <br /> SOLVENTS},4, ,1I 1 D F 4 1 P D001 <br /> X a. 4 ROG PER RIDE,AQUEOUS EDD81 141 <br /> SOLUTIb S,5.1 ( 1 D F 28 P <br /> 14,Sgal Handling rnsburAlona and Addigonall lrVoratatiort ER,r5eYV1Ee Conncted by VESTS. + Coattact n�ned by e� <br /> ea tho ter o <br /> WD <br /> add or sub';tm to addition rtm aq eneMes behAt -- 1 RG:1 8 71503 A: <br /> U� 7 $5 1 3 A, ,7.UI 80A 3}S[tG:133riigg AUt.-DEjgRtNc(NS 4)�141A W:71501 A:AZURPK51 <br /> 1A GENERATOR' FEROR'8 CERTIFICATION;I hereby declarethat the oontonle of this c wownent are fulland accurataly d"aled above by the proper shlppkV name,and are cfaseCled,packaged, <br /> marked sod laboledlplararded,snd are In all mPocla In proper condltlon for trarteport amordfng to gouble InWTWonef end national governmental regulations.Import shipment and i am the Primary. <br /> Exporter,I certify that the contents of M oonsignment om mr to the terms of Cts abohed EPAAdulowledpmemt of Conant <br /> I csrdfy that the waste minimizACon statement Idergod In 40 CFR 262.27(e)(If I am a tarps quantity generator)or(b)(dl am a small quontdy genaralor)Is to, <br /> Eaanerala'&Mror's Pilnbedqypfd Name Signature Year <br /> tt3.Intanwonalis ©importtoU.3. ❑Evortfi.tl.S. Pat Iexk: <br /> ? Thwwportar signature(for cavorts only): Daly w4h U,3.: <br /> w 17,Transporter AdstaModgIawl of Recelpt of Moledals <br /> Transporter 1 nteruf oma f S Month Da Year <br /> Trans Pon erne 81grr N Month Day Yaw <br /> � C p <br /> 18,Dteaapancy <br /> 189.Ctisrxepartay ImdkurCam Space ❑ (w.* ❑Type ❑Residue ❑Partial Re .U. ❑Ful Fto*don <br /> MaftLllfarena Number. <br /> 13D.Alternate Fps 4(or(0enemtor) U.S.EPA ID Number <br /> V <br /> uQ. Faclihyre Phare: <br /> Ise.SignatureolMemate Ratf arGerMW) Moft Day Year <br /> 19.Hazardous Waste Report Management Mothod Codas(Ls„;odea hszardoue waste treatment,disposal,and r ecya ng aysM*) <br /> A 1, 12. Hl I,, <br /> 4. <br /> MIT <br /> 20,Dealpneted Facility Owner or Operair.CWMc o f reoeipt of us materials covered by tits mank;v4as wdYin Item 16a <br /> month <br /> EPA Form 87a22 fRev,1217)'Previous adiUnr►s are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />