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Pleaseprint or type. Form Approved,Oli No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator iD Number 2.Page 1 of 3.Emergency Response Phone 4.bkwftd Traci NumberQ <br /> WASTE MANIFEST O 0 1 b 2 1 982 VES <br /> 'Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> VEOLIA ES TECMICAL 501-ill '..L.C. <br /> 1125 HENSLEY STWET <br /> ill 815-2201 RICHI01®, CA %1101 <br /> Generator's Phone: <br /> 6.Transporter 1 Company Name VEILIA ES TECHN]i "IONS U.S.EPAD,uD Or 8 0 6 3 1 3 6 9 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> a <br /> 8.Designated facility Name and Site Address U.S.EPA ID Number <br /> FED EXfifftM � AR000266247 <br /> 12091 839-2019 5655 HOQD WAY, TRACY, CA 95377 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit <br /> 13.Waste Codes <br /> HM and Packing Group(fi ani � No. Type Quantity Nt.Nol. <br /> 1 NONE NE�!-RCRA HAIR MIS BASTE LIQUID (LATEX t VF <br /> o PAINT) (OIL) <br /> a <br /> LU <br /> Z 2. <br /> LU <br /> 0 <br /> r <br /> 3. <br /> 4 <br /> 'Special Handling instructions and Additiona Information <br /> REJECTED i`iN NRNIFE5T PGyLNt 1.001750258VE5 111 <br /> 15- 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,and are classified,packaged, <br /> marked and labelediplacarded,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 Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment 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)(if I am a small quantity generall is true. <br /> Generator'sfOfferoes PrintedlTyped Name Signature Month Day Year <br /> 1 99 � <br /> �M". <br /> 16.International Shipments <br /> i= ❑Import to U.S. ❑Export Irom J S. Part of entrylexit: <br /> ? Transporter signature(for exports only), Date leaving U.S <br /> rx 17.Transporter Acknowledgment of Receipt of Materials <br /> w <br /> Trans�°rter <br /> 1 Printed(Typed Name Signat Mom Day Year <br /> a JO�IlfJ Kill Z- <br /> zZ <br /> Transporter 2 Printed/Tiped Name Signature Month Day Year <br /> a <br /> f- <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space ❑ Quantity ❑Type yp Residue Ll Partial Rejection Full Rejection <br /> Manifest Reference Number <br /> F 18b.Alternate Facility(or Generator) U-S.EPA ID Number <br /> 3 <br /> 5 <br /> LL Facillty's Phone; <br /> uu3 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> 4 <br /> Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C ;, 2. 3. 4, <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the mani'est except as noted in Item 183 <br /> Prin Cfyped Name Signa re Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITYTO GENERATOR <br />