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Please prim or type. Form ANmved.OMB No.2050-0039 <br /> UNIFORM HAMDOUS 1 1.Generator ID Number 7-Page 1 of 3.Emergency Response Phone4'0 01?9 umber 399 VES <br /> WASTE MANIFEST CAgoopj6d )-4--L--] I OZZ)a 18-0087 <br /> 5.Generates Name and Mailing Address YULI55A General s Site Address(d ddferant than mailing address) <br /> FED EX GROUND "SAME <br /> 5655 HOOD WAY <br /> Genera a YPhLU 95377-7217 <br /> 6.Transporter 1 Company Name U,S.EPA ID Number <br /> VEOLIA ES TECHNICAL SOLUTIONS N I D 0 8 0 6 3 1 3 6 9 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> VEOLLA ES TECHNICAL SOLUTIONS, <br /> LLC. <br /> 1115 HENSLEY STREET <br /> Facilil�s Phone: FUCHMOND,CA 94801 C A 7 0 8 0 0 1 4 4 7 4 <br /> 9a. 9b.U.S.OCT Description(ndnding Proper Shipping Name,Hazard Class,ID Number, t8.Canulners 11.Total 12,Unit 13 Watts Codes <br /> HM and Paddrrg Group(d any)) No. Type Quantity WINNal. <br /> 1' NON-RCRA HAZARDOUS WASTE LIQUID,(LUBRICATING 331 <br /> O OIL,SILICONES) <br /> 5 D F 1160 P <br /> U z. <br /> c� <br /> I <br /> [� 3. <br /> 4, <br /> 14. <br /> Special Hard"rretnldlar,s aMAd4lanai information ER Semce Contramd b9 VESTS -I- Conn a retained by enerator <br /> cconfefers cq authority on initial trapspnrter to add or substitute additional transporters on generator`s behap -I. 0 W-71529 A: <br /> 15. OENERATOR'SWFEROR'S CERTIFICATION:I hereby4edare that Ura contents of this owsignmenl are fust'and aocuratoly described above by the proper shipping name,and are classified,padwed, <br /> marked and labeledlplararded,and are in all respects in proper condition kr transport according to applImble intemabialand national govemmental regulations.N export shipment and I am Ura Primary <br /> Exporter,i certify Urat the contents of this consigin meM conform to the terms of the attached EPAAdmomedgmerlt of Consent. <br /> I ce"Urat Uri waste rrrnimiubm statement Identified in 40 CFR 262,27(a)Iif I am a large quantify generator)or(b)(if i am a small quantity generator)is true. <br /> 1109roes PrintediTyped NySignature Month Day Year <br /> Vr, Pic MAA44-rf ItA AD r2r) <br /> 16.Intamalionel Shipments <br /> ❑Import to U.S. ❑Exporl from U,S, Port of entryrexiC <br /> M Tfarrsporlersignature(for exports only); Date leaving U.S.- <br /> ad 17.TransporterAdmaMedgmenl of Receipt of Materials <br /> TFaaaWer1PrintedlT me Signa Month Day Year <br /> O <br /> 4inm 10 FM <br /> Transporler2 dnledrf Signature Month ay Year <br /> F- <br /> 18.I)iscrepency <br /> 16a,Disrleparky Ind Catip!Space ❑ Quantity ❑Type ❑Residua ❑Partial Rejection ❑Full Rejection <br /> Manifest Roferance Number. <br /> 18b.Aliemate Facility(or Generator) U.S.EPA ID Number <br /> ILL Fadtgs Phone: <br /> w 18c_Signature ofAitemate Fadfrty(or Generator) Month Day Year <br /> Q <br /> x <br /> 19.Hazardous Waste Report Management Mehod Codes(i.e,codes fa hazardous waste beasmant,disposal,and recyQVq systems) <br /> 2, 7-1. <br /> 4. <br /> 20.Dosignated FadBly Owner or Operator:Certification of receipt of hazardous matedals covered by the manifest oxcepl as ncW in Item 18a <br /> rintadlfyped Name Signature Month Day Year <br /> G wlI eg Ms <br /> EPA Form 8700-22(Roy,12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />