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Please print ortype. �L� I�IWIIQIIIIII I@ Form Ap ved•OMBNo.2050.0038 <br /> UNIFORM yAMID( a 1.Generator ID Number 2.Page i of 3.Emergency Respow Attune7001796889 <br /> M&nft9TmWngNumftr <br /> WASTE MANIFEST C A R 0 0 0 2 6 6 2 4 7 I 877' 818-OOS� <br /> S.Gerwator's Name and MaifngAddress �� �GALVAN <br /> AlI Generator's Site Address(ffdilfarenl than mailing address) <br /> FED 1X GROUND SAME <br /> 5655 MOOD WAY <br /> TRACY, CA 95377-7)17 <br /> Generaws Phorae: <br /> e.Transporter 1 Company Name U.S.EPAiD Number <br /> VEOLLA ES TECHNICAL SOLUTIONS IN ! D © 8 0 6 3 1 3 6 9 <br /> 7.Trarrspodar 2 Company Name U.S.EPA1D Number <br /> e.Designated Fadlty Name and SiteAddre"VEOLLA ES TECHNICAL SOLUTIONS, U.S.EPA ID Number <br /> L.L.C. <br /> 1135 HENSLEY STREET <br /> Fear aAhone: ]Irl 333-8001 RICHMOND, CA 94801 C A M 0 9 0 Q 1 4 0 7 9 <br /> 9a. gb.U.S.DOT Dasrxiption(including Proper Shipping Name,Hazard Gass,ID Number, to.Containers 11.Total 12,Unit 13.Waste Codes <br /> HM and Packing Group(ff any)) Na. Type Qtmtfty WVVd. <br /> c t ON-RCRA HAZARDOUS WASTE LIQUID. (LATEX FAINT. NONE <br /> 2 D I! 448 P ?31 <br /> z 2 <br /> w <br /> (A <br /> 3. <br /> 4, <br /> 14.Special Han&N Instruebons and Additional Information ER Service Contracted by VESTS + Contract retained by enerator confers <br /> 3�1A0715 4ority on initial transporter to add or substlntte additional transporters on generator's behalf -I-'I 771529A: <br /> 15. GENERATOR'SfOFFEROR'S CERTIFICATION: I hereby declare that the contents of ibis consignment are fully and accurst*desaibed above by the proper sNpping mune,aril are dassllled,packaged, <br /> marked and labeledfp'.ecanied,and are In all respects in proper rendition for transport aocordig to applicable international and natonal governmental rogufa6wis,If export shipment orad I am the Primary <br /> Exporter,I certify that the contents of this const newl conform to the temrs of the attached EPA Aclu*Wedgment o1 Consent <br /> I cer*that the waste minimization statement identified In 40 CFR 282.27(3)(ff I am a large quantity generator)or(b)(91 am a small quantity genarator)is hue. <br /> Generator'slOfiera's pdn Now Signature Month Day Yaor <br /> X 1092 22 0 <br /> 18.International Shonfats. ❑Import to U.S ❑bponi from U.S. P. of trplexit: <br /> Transporter signature(for exports ony): Date leaving Vs.: <br /> 17.TmnspaterAckmvledgmenturRecelpl of Material! <br /> qq Transporter 1 PrintodlTyped Nam Signature 1� - Month Day Year <br /> ranspoder 2 Pdintedllyped Name svotrae Month Day Year <br /> 18.Discrepancy <br /> 183 Discrepancy indication Space ❑ Ouan6ty ❑Type ❑Residue ❑Parbat Rejection ❑Full Rejection <br /> Manflest Reterer"Number: <br /> 18b,Alternate Facifdy(or Generator) U.S.EPA ID Number <br /> V <br /> ua. Fadws Phone: <br /> 18c.Signature of kIlemate,Facility(or Generator) Month Day Year <br /> Vj19.Hazardous Waste Report Management Method Codes(I.e.,codes for hazardoos waste treatment,disposal,and recycling systems) <br /> � t 2 3. 4. <br /> 20,Designated Fedlity Caner a Operator CxrrtiFcatlon of racelpt of hazardous materials covered by th manifest except as nood in Item 18a <br /> PrfnMT Name Month Day Year <br /> 01 0 <br /> 91 L2 <br /> 9 20 <br /> EPA Form 13700.22(Rev.12.17) Previous ed€tAa,, tete. DESIGNA ED FACILITY TO EPA's e-MANIFEST SYSTEM <br />