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DT( L Al RCL; 0?20 533722 " 1313132, Please print or type.(Farm designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone d.Manlleal Treckln Number WASTE MANIFEST CAR000211540 2 (800) 535-5053100 0 0 313 6 DAT 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) SBIV 30AQUIN DELTA COLLEGE SON 30AOUIR DELTA COLLEGE ^_ 2111 1011TH CENTRAL 1111111 2071 SOOUTH CENTRAL PARKURY Generators Phone: %GUiITAIR HOUSE CA 95391 (209)59B-9040 INGUNTAIN HOUSE CA 95331 12091598-9840 6.Transporter 1 Company Name US.EPA ID Number 21st Ceiritury Environmental Planagement of Caiifomia LP CAR000210617 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number GENERAL ERVIRONRENTAL 116T, LLC DDA PSC ENVIRONMENTAL SERVICES NQ` 11855 UNITE ROCK ROAD Facilitys Phone: RANP1411 eflPDOVA. CA 95742 (9161 351-09an CIPID131300134183 ga, 91h.U.S.DOT Description(inducting Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity WUvoL 13.Waste Codes I. UN1992 BASTE FLRRRAELE LIQUIDS, TOXIC, N-0.5. IKETHANOL, BARIUM, DOGS F003 11001 X CHLORIDE) 3 (6.11 PGII V l CF �'�- P 9 S51 UJI 2 193299 t4ASTE OXIDIZING LIQUID, TOXIC, R.O.S. (SODIUM CHROMATE, DOR1 D095 BOOT X SODIUM NITRATE) 5.1 16.11 P61I \ CIF P 3' UH3093 CASTE OXIDIZING LIQUID, CORROSIVE, R-D-S- (SILVER NITRATE, BOB! D902 8095 X NITRIC ACID) 5.1 (0) P61I b L CF 0 E{ P DOOA I D011 551 ° UN3281 URSTE TOXIC LIQUID, INORGANIC, N.O.S. (9ARIUM CHLORIDE, D005 551 X SODIUM PHOSPHATE) 5.1 PfII CF b (a P 14.Special Handling Insuuctions and Addihonal Information - (1) 514349-09 - ER6(131) LRDPK 9RH1-FL111 TOX (2) 514350-00 - ER611421 LADPK OMN93 - OXIDIZ (3) 514350-00 - ER61140) LADPK 6HH4 - OXIDIZE (1) 514351-00 - ER61151) LOW 91195 TOXICS 15. GENERATOR'SiOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consgnment are fully and accurately described above by the proper shipping name,aM are dassifled,packaged, marked and labeled/placarded,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 Exporter,I partly that the contents of this coniygnmenl conform to the terms of the attached EPAAcknowledgment of Consent. I certty N 1 the waste minimization statement idbnUed in 40 CFR 26227(a)(d I am a large quantity generator)o b)(if I am a small quantity generator)is true. Generator Printetl7fyped /I Sign Monty Day Year 1 0 1B.lntemabonal Shi ents zImport to U.S. ❑Export from U.S. Pod of tryleAt Transporter signature(for exports only): Dale Ie ng U.S.: w 17.TmnspoderAcknovdedgment of Receipt of Materials - ~y. Transporter Printed/ryped Name Signature Month Day Year y v -, /Qsl 4X /( Z Transporter2 PrintedrTyped Name Signature Month ay Year a' f t18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity El Type L1 Residue ❑PaNat Rejection 1:1 Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number J V LL Facility's Phone: W .18c.Signature otAltemate Facility(or Generator) Monti Day Year Q Z y19.HazardousWWaste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and reg/ring systems) /yam G 1. 4q / 2. ��/ 3. / /• Y/ 4. 1/ 20.Designated Facility Owner or Operator.Ced�Calion of receipt of hazardous materials covered by the manifest except as road in Ilam 18a Pri yped Name N�� Signat Mpnt Day Year ns}ih, U, `J EPA Form 8700-22(Rev.3-05) Previous actions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) 11176.0216