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Please print or type. Form Approved.OMB No.2050-0039 <br /> ���� 1.Generator ID Number 2.Page 1 of 3.Emone Mantled ergency Response Ph4. Tracking Number <br /> NIVORM HAZARDOUS <br /> y,!?ISl'E MANIFEST C. A R 4 0 Q s ci ti 2 4 ? 18??j II1 (Jt78? _ Z1�48 VES <br /> L.. 'v. Generator's Name and Arailin Address ,E Generator's Site Address if different than mailing address <br /> g Ili I3A1�7�1�+I ( g } <br /> )a ED EK GROUND S A <br /> EL655HOOD WAY <br /> CY,CA 95377-7217 <br /> Generators Phonc: 209 830-2569 <br /> G Transporter 1 Company Name U.S.EPA la Number <br /> CILIA ES TES HMCAL SOLUTIONS 6 9 <br /> 7 1'ranspnrtar 2 Company Name U.S EPA ID Number <br /> 5c. noted facility Name and Site Address U.S EPA 1D Number <br /> VEOLIA ES TE `FINK: ,SL)U1'I7iC NS, <br /> L.L.C. <br /> 1125 HENSLEY STREET <br /> �R-lO'TI1k+1.OM,CA 94801 <br /> 1-aciVy'a Phone: 510 233-5001 C A T Cf 1'% 0 0 1 4 0 ! _cr <br /> 9, 9b-U.S.DOT Des,rnplion(including Proper Shipping Name,Hazard Class,fD Number, 10.Confainets 11.Total 12.Unit <br /> Hhi; arid Packing Group(if any)} 13.Waste Codes <br /> f No. Type Quantity Wt.lvol. <br /> ry 1.UN1978i WASTE PROPANE,2.1 D001 <br /> �y I C. t 2 P 331 <br /> Eli - <br /> 3{ z'1`ION RC`FtA I-IAZARP7r;RIS WASTE LIQUID,(LATEX PABIU, <br /> OIL) <br /> 1 D I'_ 254 In <br /> 3.I`It'NRC`I A HAZARDOUS US WASTE LIQWD,('LAT>-x PAINT, 831 <br /> OIL) ., <br /> 3 D V1 750 P <br /> :14.;pedal HSnclling Instructions an,iAddilional Infotmalion ER Service Cbrit acted by VESTS + 03rttcecf retained lir tgen.rafc=t cutlet.; <br /> agency atlthii ity on initial txrdrt< Aut t j tidd fir s bstitute aMitirmal uanspwPfs tib€g neratcws behalf _I_ I)ERG:115't3 101020 <br /> ACCVMPRCPANE 2)W.71529 A'.PTA071S2 9 3)W'--71`29 A.PTA071529 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified.packaged. <br /> marked and Obeledlplacarded,and are in all respects in proper condition for Transport according to applicable international and national governmental regulations.If export shipment and I am the Pdmary <br /> Exporter,1 cerlify that the contents of this consignment conform to the terms of the attached EPAAcknow€edgment of Consent. <br /> I cedily that the waste minimization slatemenl identified in 40 CFR 2$2,27(8)(if I am a targe quantity genera(or)or(b)(if I am a small quantity generator is true, <br /> eneralor'sf01ferars PrintedlTyped Name Signature Month Day Year <br /> 0 £ 1 B t 9 <br /> 1t3.InlernaiionalShipments <br /> ❑import to US. ❑Export from U.5 Part of enlrylexil' <br /> w €ransportei s+gnafure(for exports only): Date leaving U.S.: <br /> 0u 17.Transporlar 6.cl.nowledgment of Receipt of Materials <br /> I— Trarnncrter 11 Prkntedffyped 03m2 Signature Month Day year <br /> a� <br /> JOEL SILAS 111 �� '`4} 0 G 1 f; 11 9 <br /> Transporter 2 P intedlTyped Name Slg ature Month Day Year <br /> w 13 Discrepancy <br /> tea-Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑FuII Rejection <br /> Manifest Reference Number: <br /> F- <br /> Pb.Alternate Facility tar Generator) U.S.EPA ID Number <br /> �8 <br /> c_s <br /> r� Facility's Phone_ <br /> w 188 Signature cz(A.ltsrnate Faculty(or Generator) Month Day Year <br /> 19.1lazardoas 4Vaste Report Management Method Codes)i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2. 3. 4. <br /> '20.Designated Facility Ovrner or Operator:Certification of receipt of hazardous malefiats covered b the manifest exce i as nded in Item 18a <br /> P P y P <br /> Pri(lcrl'Typed tJame Signature Month Day Year <br /> EPA Form 87100-22(Rev12er) Previous editions are ohsolele. DESIGNATED FACILITY T4 EPA's e-MANIFEST SYSTEM <br />