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Please mt or Form raved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1>Generator ID Number 2.Page 4 of 3.Em Mer Reaponae Phone ltarOWngNu VES�+ <br /> WASTE MANIFEST 001792371 11 ES <br /> 6,Gam$ratoi'a Name amd Me11nomdrees <br /> F&D EX GROUND YULISSA GALVAN <br /> 5655 HOOD WAY <br /> �vlwr 95377-7217 <br /> B.Transporter 4 Company N <br /> EPA ID Humber <br /> 7.Transporter 2 Canywny Name N <br /> U.S.EPA ID Number <br /> TRISTATE MOTOT a"1 M 0 D 0 9 5 0 3 $ 4 9 8 <br /> B.DeelgmaW FacilAy Naw and Sh Address U.8.EPA ID Number <br /> VEOLIA E5 T$CHNICAL SOLUTIONS, <br /> LLC. <br /> 1704 W.FIRST STREET <br /> Factllty+ei'trorre AZUSA,CA 91707 C A 0 0 $ <br /> 9a. 9b•U.S.DOT DosaWm(Inducting proper Stepping Marne,Hazard Claes,ID Number, 19.Carastnera <br /> HM and Pacidng group(f-y)) ii,Total I 42.Unit 13.Waste Codes <br /> No, Type 4uani ty miVol. <br /> X1' <br /> UNI <br /> y43 ASTB FLAMMABLE LI DS.n.o.s (ETHYL 1•'003 D001 33I <br /> MR PETROLEUM DISI aye 3.11. RQ <br /> 1 D P 1 6 6 P F00S D035 <br /> X 2' UrNp317S.WASTE SO DS C(3N L$ F003 359 <br /> OLUV 7n5, .[;II,RSGONffi~ <br /> 1 1) F 39 P i30{k) <br /> yx 3 SOLU1'I�?N5.STSHYDROGEN PEROXIDE,AQUEOUS D001 791 <br /> � i D F 61 P D002 <br /> X 4 � PTE CQ( xA55� �[ vVF3IDLA4Wk SgI?1i111d IC D007 <br /> HH POCHLO TES.$, 1I,1�Q{l 10 ) 1 D F 1 0 6 P 123 <br /> 44,spade! rxlElrlg I dldorta!Imiammatlom ER Service Contaacted by VESTS + Coon=retained b 'en lto}rg��p <br /> confersjgen�aithOnt on>Itu altr0o> 13m W19039��po VF� L Fdi #0 1S� A E1RPKi11ABPACK <br /> 710 A7AZ11PRI $>3 PAG <br /> t 5. amERATOR'$IOFFFRBii'S CERTIFiCATiON:I hereby dedam Thal the oomanta of ft carWgw ml ere iufly and e=ratWy desarbed atwva byproper o*pkrg name,and are daseffbd,pacitsgad, <br /> marked and Iebeladlplacarded,and are In a1 respects In Proper oorxg m Wr larrsPort waling to applk"inwamlonei and negate!goaiernmamW rtguisWns,H <br /> Ewrtar,I ON*ttral the oontamtsof thio oonalerrmemicwftn m Bw femme of the attached EPAAckno 44mant of Cen$$nk eaPortahlpmeid and I am floe Primary <br /> I ou*drat thewaste minirnkmlon skbmerd I&nVW 0140 CFR 26227(x)(II am a large quar>fity generalx)or(b)('dI an a aw gm*generator is true. <br /> (3saer" $Prlalemwod 1 N Signature fh Year <br /> A <br /> Sis Gf v il JA 6"A —M <br /> �, 16,Imternatlonel <br /> Trenaporter slgmalure(for exports orslyElImport w u.5. Ew from U.S. Pkxti;Date wft ' <br /> � 47.TransporiNrAdmawladQmardufRapglpioff�eMrMts <br /> T 4pod Name S Doty Year <br /> Trampater r#wmre 2 <br /> R k 00 Day Year <br /> ?o <br /> t8.Dlsorepaacy <br /> 18x,D€saslwnayr Imdkaliom Space El ❑Residua ❑Partlel Ref e w ❑Fu1 Ral$oUpo <br /> MaNfesl Ref$rertce r: <br /> 46b;Altemate RdRy(or Canasta) U.S.EFA ID Number <br /> V I <br /> FaditVa Phone <br /> 16c Signature otAfternate Fadl or Gem br Mwth y ee< <br /> � 49,Hazordoua Waste Roparl 6leraagsareM Ate9sna Codes(I.e,, for hazandusrs waste Yeafrnert,d recycfs�g ayateme) <br /> 4, <br /> 20.DesJgnatad FadfHy mar ar 4parabr Certifiaa of reo$dpt of frazerdou lactate coasted by tlla ma 16a <br /> RkWdqyped amscyraq <br /> U(IrMA/A t <br /> EPA rWWW22 ev,i2•44aditiams ared6sAld. NATED FACILITY TO EPA's"A FEST SYSTEM <br />