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111111111111111111111111 Forte ADproved. OMB No. 2050-0039 4 GENERATOR. o- 2 - I _ . _ . „ .... UNIFORMHAZARDOUS WASTE MANIFEST 1. Generator ID Number CAR000 1 A 6 1 Si 2. Page 1 of 2 3. Emergency Response Phone On II LI1Aft2 4. Mentfust Tracking Number 001797847 VES Generator's Name and Mailing Address Generator's She Address (if different than mailing address) FEDEX GROUND - STOCICP3N REIF SAME 6444 ARCH ROAD 1-9019§terA. 95215 I Transporter 1 Company Nam209 3904094e U.S. EPA ID Number VE011A ES TECIIPLICAL SOLUTIONS INID01106313 6 9 Transporter 2 Company Name U.S. EPA ID Number MP ENVIRONMENTAL EIFICVXBR I C A T 0 0 0 6 2 4 2 4 7 Designated Facility Name and Site Address U.S. EPA ID Number WALLA ES TECHNICAL 8011111014S, L.LC. 3704W. FIRST STREW Facilitv's Phone: Rfi 314-51 17 AZUSA' CA 91102 I C A D 0 0 11 3 0 2 9 () 1 ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Nunter, 10. Containers 11. Total 12. Untt 13, Waste Codes jim and Packing Group (If any)) No. Type Quantity WLNol. 1. U11263, WASTE PAINT ItELA1E23 MATERIAL, 3, II, RQ 13001 X 133001) 1 DM 60 P 331 . X 2. UN1993. WAS'Ill FLAMMABLE LIQUIDS, n.o.o.. 11102 U154 1fl20 (METHANOL ACETOPEB), MI 1 D F 45 P U003 L1161 331 X 3* UN3267. WASTE CORROSIVE uCtua BASIC, BM* 341 ORGAN/C,a.o.s.„ (AMYL DEASHIHYL BENZYL AMMONIUM CHEOltIDR), 8. ii 1 D F 30 P D002 -- 4. NON,RCRA HAZARDOUS WAS1E Sam, (OILY DEBRIS) 352 . 1 D P 60 P 14. Special Handling Instructions and Additional Information BR Sank' Coolroctid by VESTS + Contact Mind by smator cram gooey authority an initial traorportcr to odd or oubontoto additional oiospottcri on gocilior's Wolf. + 1) IIR971211 W:1099904 kAZUDED IRIS 2) ERG 1211 W:1099905 kAZUDPK3 1114 3) EIR0J53 W:174265 kAZURPICIDA 1130 4) W:1053871 k AZU4ISIDEBRS(NS 1155 I 15 GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by tha proper shipping name, ant are classified, packaged, marked and labeled/placarded, and are in all respects In proper condition for transport according to applicable international and national governmental ragulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) Of I am a small quantity generator') Is true. Generators/Offerors Printedflyped Name Signature Month Day Year is esf k)e-el Ferry - vizo.nrr. 1 4' Ii) 1 10 1 12 3 16. International Shipments Export from U.S. Port of entry/exit Import to U.S. Transporter signature (for exports only): Date leaving U.S.: rRANSPORTER I 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Or Month Day Year 5 741-VAI Arie4f,r_ I I Oa 1 0/ I , Transporter 2 Printed/Typed Name Signatu \ Month Day Year Jo-$ 7;).$1 49 ; Ai ; 1 .e.- P37 C#P s a I z_ 1 ,x) 17_3 1.---- DESIGNATED FACILITY ---)- I- 1----- 18. Discrepancy 18e. Discrepancy indication Space fl Quantity LIType Residue Partial Rejection LI Full Rejection Manifest Reference Number: Alternate Facility (or Generator) U.S. EPA ID Number I Facility's Phone: I Signature of Alternate Facility (or Generator) Month Day Year I I 19. Hazard s Waste Report Management Method Codes (I.e., codes for haza •.• : ,: le treatment, disposal, and recydin systems) 1. i \ 2. \ 20. Des ated Facill er or Operator: Qedtfication • receipt of h • s materials co the manifest excep as nded li tem 18a Prin yped N 5h 1 ifDay .?...Y; / 1 IIIIV I Form 8700- ev. -17) Previous edition re obsolete. s e-