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I Please print or Mn.~ 11111101 1111 Form AWDved.OMB No.20 M30 UNIFORM HAZARDOUS 1•Generator 10 Number2.Page 1 of 3.Ertnergency Response Phone 4.Manhd Traoltmg Number WASTE MANIFESTRjjAg1001792033 vEa7' 5,Generators Name and Malting Address WLIJSA GALVAN GesiemWs Site Address(ifd tferwd than mailing address) FED EX 0ROUND SAME 5655 MOOD WAY RAA 93377-7217 9 gag 11560 nano s one: 6.Transporter 1 Company Name U.S.EPA ID Number VEOLIA ES SOLUTLONS N 3 D 0 8 0 6 3 1 3 6 9 7.Transporter 2 Company Name U.S,EPA 10 Number 8.Ds*naled Faallty Name and Site Address U.S.EPA ID Number VEOLEA ES TECHNICAL SOLUTIONS, L.L.0 1 125 HENSLEY STREET Fadi es Phone: RICHMOND, GA 94901 CAT O B O O 1 d 0 7 4 9a. 9b,U.S.DOT Description(ung Proper Shnpping Name,Hazard Class,tD Number. 10.Containers 11.Total 12.Unit 13,Waste Codes NM and Packing Group(It any}) No. Type Quantity W€Nol. o X 1' UN 1044, FIRE EXTINGUISHERS CONTAINING COMPRESSED 331 0 OR LIQUEFIED GAS,2.2 I C Y 43 P 2' NON-RCRA HAZARDOUS WASTE LIQUID,(LATEX PAINT, 331 01L) 3 D F 674 P 3. 4. 14.Spada!Handling lnsincifons and Additional Information Ei R Service Contracted by VESTS + Contract retained by generator confers agencya�cauthori an ini4al tTan orter to add or substitute additional trnsporters on generator's behaTE -I- I)ERG:12r W:7i493 agency 2)W:7I579 APTA0715a9 15. GENERATOR' ID"ERAR'S CERTIFICATION: I hereby declare that the contents of this mnsgnmenl are fully and wwrately described a wm by the proper shipping name,and are classified,packaged, marked and labeled0kanded,and are in all respects in proper condition br bonsport aceordirg to appl cab€e mlemaboneland national governmenlai regulations,N exportsh€pwl and I am the Primary Exporter,I certify thatthe oantonts of this conslgnmenl oontarm to the tarns of the attached EPAA&jwMedgmont of Consent. I certify that the waste minimization statement identified in 40 CFR 26Z27(a)(it I am a taMa quantity generator)of(b)(di am a small quantilly generator)is true, WsIqLeVs PrintedlTyped Signature MonthDay Year, krwo _J 16,Internationol5hlpman Transporter sgnalure(for exports only): import to U.S. ❑Export hum U.S. Pod of f xi Date lea S: W 17.TranspatarAdvowledgment of Recelpt of Materials I— Tr 1 Priniadlfyped N Signa A1on Day Year Transporter 2 Printsdfiyped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy IndxAtion Space ❑ Quantity ❑Type ❑Residue ❑Partial Relecbon ❑Fug Rojed. Man€fast Reference Number, 18b.Alternate Facility(or Generator) U.S.EPA 10 Number 3 U LL. FadWs Phone: W 1k.Si nature ofAtemateFadfity{orGanerata) Month Day Year S 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatmerd,disposal,and reoyclmg systems) C1. lLI L 3. 4, 20.Designated FaclRy Owner or Operator.Cortiircabon of recoOt of hazardous materials covered by the manliest except as noted In Item 18a Print ypad Name S nature Moth Day Your m O1�`� z EPA Form 8700-22(Rev.12-17) Previous editions areobsole€e. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM