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n-A <br /> 1703 <br /> F release pent or ty . Form Approv .OMB No.2050-0039 <br /> UN€FDRMHA2ARQDUS 1.GeueralorlDNumber 2.Pagel of 3.Emergency Response Phone 4.Manifest TraccEngNumber <br /> WASTE MANIFEST CAL000273993 000276708 Sflfl S33 8253 AT <br /> 5.Goneraters Name and kbllingAddress ATTN:Anthony Flores Generators Site Address(if differentthan mating address) <br /> Tracy Unified School District TUSL) W661:Hlgh School <br /> 1875 W Lowell Ave 1775 VV Lowell Ave <br /> Tracy,CA Tracy,CA 95375 <br /> Generators Phone; <br /> 209-321-6215 <br /> 6.Transporler 1 Company Name U.S.EPAtO Number <br /> Ingeni4m (Sacaramenfo)r***ERIPHONE-Custl0#8766-OOW***) GAR000179747 <br /> 7.Transporter 2 Company Name U.S.FPAID Number <br /> 8.Designated Facilty Name aiid StleAddress U.S.EPAID Number <br /> Clean Harbors Aragonite,LLC IITI]981551177 <br /> 41600'Norih> ty Road <br /> GrantsvlNe,.0 84n29 <br /> Facifil}es Phone: '435-884-8100 <br /> ga. 9b.U.S.DDT Despiption(rrduding Proper Stopping Name,Hazard Gass,Ib Number, 10,Containers 11.Total V.Unit f3.lNasteCodes <br /> HM and Paddng Group[l any)) No. Type Quantity WINa1. <br /> a hA3077,Hazardous waste,solid,n.o.s,(sliver,acetbrfe),9,III 35205 <br /> DOT ERC#f 71 f V1 ! F003 ' <br /> to <br /> cn <br /> s. <br /> 4. <br /> 14.Sputa[Handlkrg Inabuctians and Additional InfonnaGan <br /> 083190 80 151842 <br /> 1)CH818285 "! ' <br /> Contract retained bygenarator confers Agenoyauthori€yon€r0a€transporterto add-or substitute addiftonal transporters oil generators behalf. <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare Uta!the contents of this consignment we fully Arid accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are In all respects In propercondition forlrensport according m applicable Intematianaland nation vem€nenlat regulations.If export shipment and I am the Primary <br /> Expo6r,€eekglylhalttie contents of tfiis consignmeatconforrin b the temra of the attachad EPAAcaro4edgmentof Consent <br /> I certify[het fhewaste minimization sta nt Idandtied(n 40 CFR 282.27(3)(d I am a large quantity generator)or m a H qua lily generator) tree. <br /> Ganeralors)D rot'sPrinfed f Mme p � � Slgnatore ,- Mon Day Year ' <br /> e 16,International Shipm to � <br /> p <br /> [I Import 1.U'S' ElExpodfre.93. Porlofe IexiL <br /> Transporter signature(forexporls only): Data teavrng U.S,: <br /> W 17.TranaportarAclno gment o(Receipt a[Materials <br /> Transporter 1 Frinle<Vryped Name Stgnature Month Day Year <br /> p m/}�/• <br /> „''Z Transporter 2 Printedtypad Nama SignaVe Month Day Year <br /> 1 e'Discrepancy <br /> 18a.Discrepancy indirafinn Space Q ouaney ❑Type ❑Re/d', Partial Re)eclion ❑Full Repe ft <br /> Manifest Rere'renoe Number: <br /> 18b,Aftlarnate Fadlity(or Genuator) U.S.EPAID Humber <br /> Zi <br /> 44- Facility,Picone: <br /> 18G,SIgaatureotAgemale Facility(arGeneralof) Month Day Year <br /> N19.Hazardous 4Nasla Report Management Method Codes(I.e.,codes for hazardous haste fkeahnent,disposal,and recycling systems) <br /> 20.Designaled Facility Owner or Operator,Cedificattonof receipt of hazardous materials covered by the manifest except as noted in Rem 18a <br /> Pdme&Typ d ame Signature Alonth [lay Year <br /> EPAForfn 8700.22(Rev,t2- ) previous editions are obsotele, ESlGhIATED FACILITY TO EPA's a-MAW EST SYSTEM <br />