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Please print or type. Ferri Approved. OMB No. 2050-0039 .< GENERATOR k I ..., UNIFORM HAZARDOUS WAS MANIFEST 1. Generator ID Number C A C 0 0 3 1 0 7 6 9 4 2. Page 1 of 1 3. Emergency Response Phone 800-899-4672 4. Manifest Tracking Number 0 0 6457146 GBF Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) Velocity Rail Solutions 121 W. Election Rd_ 001 Diamond Street Draper UT 04020 Stockton CA 05205 Generator's Phone: 3 0 3 7 4 6 - 3 5 8 9 I Transporter 1 Company Name U.S. EPA ID Number NRC Environmental ServiGes I C A R 0 0 0 0 3 0 1 1 4 Transporter 2 Company Name c-M1Y09\rlentIll • - U.S. EPA ID Number 1 -06p(2tlOS tylc ic,6 co o 0 :2_111;15 8. Designated Facility Name and Site Address U.S. EPA ID Number Hamlet TSDF Inc. 160 W. Monte Ave siogmington CA 82316 Facility's Phone: 909 421-2012 IC A D 9 8 2 4 4 4 4 8 1 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 1-IM and Packing Group (if any)) No. Type Quantity Wt.Nol. 13. Waste Codes Non-RCRA Hazardous Waste, Liquid (Water w/Diesel Fuel Residue) 331 0 0 4 DM tCtle° P Non-RCRA Hazardous Waste, Solid (Aaphalt/DebrtaIDIesel F-ueI) 352 0 0 2 DM 1 660 P Nen-RCRA Hazardous Waste, Solid (Soll/Dlesel Fuel Reeklue) 352 511 0 0 1 DM -500 P 4. Special hjandlIng Instructions and Additional Informatigq Profile Prole # 9B1 21030206 -r ptofile # 9B2 210302052.?( Profile # 9B3 21030204 PPE** PO/JOB # 163133 ‘)04 q. 0 i b LI 1 1 **Wear Proper GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, ard are classified, packaged. marked and labeled/placarded, and are In all respects in proper condition for transport according to applicable intemational and national governmental regulations. If export shipment and tarn 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 minimizafion statement identified in 40 CFR 26127(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year C-O CLINOP 1 eeD, (3)k._-- I zi i- g 16.1eternafional liii Ship lents Import to U.S. Li Export from U.S. Pt of entry/exit: Transporter signature (for exports only): Date leaving U.S.: TRANSPORTER 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 PrIntecUTyped Name Signature WI (ANAL\ 1.'N'ea4) 1 440Llt Month Day Year 2-C'ft.m..---' 1 03 105 1 21 Transporter 2 Printed/Typed rOUNC01 temo Sign ur Month Day Year I 3 I 121 ) FACILITY --0- 18. Discrepancy Discrepancy Indication Space Quantity LI Type Li Residue El Partial Rejection LII Full Rejection Manifest Reference Number. Alternate Facility (or Generator) U.S. EPA ID Number Facility's Phone: I ] -4-- DESIGNATE 18c Signature of Alternate Facibly (or Generator) Month Day Year I I 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 1. lits-tt 2. tkV-1.( 3. tivi 1 4. 20. Designated Facility Owne, or Operator: Certification of receipt rdous m tenals covered by the manifest except as noted in Item 18a '"'S Printed/Typed me Signature Month Day Year LIAcws4,- 1_ I 15 1 11.12-i .....„,, „,....... . . orm Of UU-L2 - rev ous ethtions are o so e DESIGNATE ACILITY TO EPA's e-MANIFEST SYSTEM