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PI�e print.or type.(Farm designed for use on elite(12 Tach)typewriter•) Form Approved.OMB No.2050039 <br /> UNFOW HAI.ARDOUS 11.GenlarallorlDNumber 2.Page i of 3.Emergency Response Phone 4.Uwftd Trieidng Number <br /> WASTE MANIFEST CAL00025091 1 800.535-5053-WOTRAC 010095105 JJ K <br /> 5.Generators Nance and Makq Address Generaieft Ste Address(f differ d than mailing address) <br /> A&A CONCRETE SUPPLY,.INC.(SHIPPER-OFFEROR) <br /> 4035 E MARIPOSA RCI. <br /> STOCKTON,CA 95215 USA <br /> 1:I Gerwatues Phone: <br /> e• &TMWOFter 1 Company U.S.EPA ID Number <br /> CLEANTECH ENVIRONMENTAL CAUOQ03304W <br /> F 7.Trarspnrter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Fanitty Name and SIM Address U.S_.EPA ID Number <br /> VEOLIA ES TECHNICAL SOLUTIONS LLC nwmrexrvrra <br /> 1704 W. 1 ST STREET +�+�•� ,�,�, <br /> AZUSA.CA 91702 USA <br /> Fats Phone:625 334-5117 <br /> ga 9b.U.S.DDT Desc*60n(srdtrdrrg Proper 5lripping Name,Ffezard Ciar;s,16 iJurrrber, 19.Containers 11.Total 12.Unit 13.Wada Codes <br /> HM and Paoki g C—v(b any)) No. Type Quantity WLNol. <br /> WASTE AEROSOLS,FLAMMABLE, n.0.e.,21. UN1950{EACH NOT � am � 0 P D001 <br /> EXCEEDING 1 L CAPAC" <br /> W I <br /> Z 2. <br /> LU <br /> C9 <br /> f <br /> r <br /> E^� 4. y <br /> E' <br /> A <br /> U-Special Handlingy�Information <br /> . 3e1)WIP9� 1�4p `7O USE GLOVES AND GOGGLES TRUCK* 3 <br /> l BUSED AEROSOLS-PAIN1) <br /> -CAU-ER MUST IDENTIFY CLEANTECH ENVIRONMENTAL AS REGISTRANT: tNF17TRAC 800-53&WW <br /> i <br /> 15. GENERAT0R%K*FERORS CERTIFICATION: I hereby declare twat the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,padcaged, <br /> marred and tabeledlplaearded,and are in all respects in proper oondtkn for transport aocarding to applicable international and national govemmorftl regulations.If export shipment and I am the Primary <br /> Exporter,f o:rtify that the oentents of this consignment conform to the tens of the attached EPAAdmmowtedgmanl of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b}(d I am a small quantity generator)is true. <br /> Ci <br /> Generatorsls ypedNa Signora Month Day Year <br /> 16.Lniearrational Shipments <br /> ❑Import tD-U.S. ❑Export from U.S. Port of entrylexd: <br /> Transporter stgnatae(tor exports only): Date leaving U.S.: <br /> 17.TranspoftAckraMedgmem of Receipt of Materials <br /> a Tmnspuier 1 PmtedlTyped Name Si nalureDay Year <br /> - 13 1 /;,- <br /> Z <br /> Tmnsporlei-2 PlilintediTypuffiaFm S' Month Day Year <br /> vr <br /> F <br /> 16,Discrepancy <br /> 188.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Parcel Rejection ❑Ful1 Rejection <br /> Manifest Reference Number. <br /> 18b.Wtamate Facility for Generator) U.S.EPA ID Number <br /> C� <br /> FadWs Phone: <br /> LU18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous.waste treamoent,disposal,and recycling systems) <br /> 00 1. 2, <br /> ted Owner or ofilrecept of hazardous materials covered by the except as noted in j <br /> le <br /> 7-1 <br /> re Month Day Year <br /> EPA 70x22[Rev,3-05) Previous editions are atrsdete. D IGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />