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t Please, int or type. Form Approved.DMB No.2050-0039 UNIFORM HAZARD Lj'J1OUS 1 Generator BNumber 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number YVASIEMANIFEST 521{ 1,82 YES Generators Name and Mailing Address Genefatofs55lip Address(ii deferent than mailing address} VEOLIA ES MMICAL GMTI 1i L.L.L. 1125 HENSLEV STREET (626) 9!5-2201 RICHND, CA %WI :6. enerators Phone: Transporter 1 Company Name U.S.EPA ID Number 'i ES TECINICk SOLUTIONS N 3 C 0 8 0 6 3 1 3 6 9 7.Transporter 2 Company Name U.S.EPA ID Number I 8.Designated Facility Name and Site Address U.S.EPA ID Number FED EX6ROLOO £ AA 000266247 12091 839-211 5655 HOOD WAY, TRACY, CA 95377 Facility's Phone, 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number. 10.Containers 11.Total 12.Unit HM and Packing Group('d ani No Type Quantity N,.,Voi. 13.Waste Codes 0 1. NONE NOW-KRA HAZARM MASTS LIQUID (LATEX 33I F PAINT} (OIL) a a w Z 2. LU ILD 3 4. Special Handling lnslruclions and Additional information 9EJEC T f ti 1i NRNIFEST K Lq: 1 A%01 '%VES 1/1 15. GENERATOR'SIOFFEROR'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, 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 EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 21(if I am a large quantity generator}or(b)(it I am a small quant general r)is true. GeneratorslOfferors PrinledrTyped Name Signature Month Day aYear AA-cm iii f*N 11 J 16.International Shipments import to U.S. trY ❑ ❑Export from U.S. Port of en !exit Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials I— Transporter 1 Printed/Typed Name Signatu Month Day Year u c`�' �--�- _ 7 Z co Z Transporter 2 PrintedrT ed Name Signature Month Day Year a r 18.Discrepancy 1$a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejectien ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ LCL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Feer a Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) ir ,. r 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as ri in Item 183 PrintedrTyped Name Month Day Year 1 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY COPY IF YOU RECEIVED THIS MANIFEST,YOU HAVE RESPONSIBILITIES UNDER THE e•MANIFEST ACT.SEE INSTRUCTIONS ON REVERSE SIDE.