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111111111 II III! ! IIIIIIIIII Please pnnt or type. Form Approved.OMS No 2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2 Page 1 of 3 Emergency Response Phone 4.Manifest Tracking Number VES— WASTE MANIFEST 001521982 VES Generalo s Name and Mailing Address Generator's Site Address(if different than mailing addressi VEDLIA ES TECHNICAL SMUTIONS, L.L.C. 1125 HENSLEY STREET (626) 815-2201 RICHMOND, CA 94801 Gereratoi Phone: s.Transporter 1 Company Name EPDNumber VEOLIA ES TECHNICAL SOLUTIONS U.S. N 1 D 8 0 6 3 1 3 6 9 7,Transporter 2 Company Name U.S.EPA ID Number 8.DesInaled Facility Name and Site Address U.S.EPA ID Number FED EX GROUND C A R 0 0 0 2 6 6 2 4 7 (209) 839-2019 5655 HOOD WAY, TRACY, CA 95377 Facility's Phone: ga. l 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number_ 10.Containers 11 Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.NoI. a 1 1OUS NON-RCRA HAZARDWASTE LIOUID (LATEX 1 OF 180 P 331 PAIN1011.) z L 3 Special Handling Instructions and Additional Information REJECTED FROM MANIFEST PG/LN: 1.001750258YES 111 15. GEN ERATOR'SIOFFEROR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledlplacarded.and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations,If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent I certify that the waste minim¢ation statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(d I am a small quantity genera r)is true. GeneratoeslOfferor's Printed/Typed Name q-r- Signature * Month Day Year Illi 1 .1 _j j 16.Interni Shipments i` ❑Impoi to U.S. ❑Export from U S Port of entrylexit: Z Transporter signature(for exports only): Date leaving U.S-: w 17.Transporter Acknowledgment of Receipt of Materials D Transporter 1 PrinledITyped Name Signa Month Day Year O � R uZ 7 7 Z z Transporter 2 Printed ped Name Signature Month Day Year t- 18.Discrepancy 18a.Discrepancy indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejecter) ❑Full Rejection Manifest Roterence Number: 18b.Alternate Facility(or Generator] U.S.EPA ID Number J_ U rai Facility's Phone: W 18c.Signature of Alternate Facility(or Generator; Month Day Year Q z Hazardous Waste Report Management Method Codes(i,e,codes for hazardous waste treatment,disposal,and recycling systems) 2. 3. 4. 20.Designated Facility Owner or Operator Certif cation of receipt of hazardous materials covered by the manifest except as noted in Item 18a Print Typed Name Signa re r Month Day Year x GYr 6Y U� U3 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM