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Please printorty�pe. Form Approved.OMB No.2050-0039 <br /> jUIIIOR€N ttq�gRppUg 1.Genaraior 10 Number 2.Page 1 c4 s.Emergency Respoase Phone 4.Man€fest Tracing Number <br /> wAsfE MName 7 cRL000273993 4V 800-633-8253 0002-76750 DAT <br /> 5.Gensraloes Hama and MAfirud Address ATTN:Anthony Flores Generators Site Address(if differentthan ma'fing address) <br /> Tracy Unified School District TUSG-Wast High School <br /> Trac W Lowell Rtee 1775 W LoWell A%e <br /> Tracy,CA Tracyr CA 95376 <br /> Generator's Plains: 209-321-6215 <br /> 6.Transporter 1 Company Name U.S.EPR ID Numhar <br /> Ingerlfurn (Sacramento)(""*ERI PHONE-Gust lD#8766-0004#"" <br /> CAR000179747 <br /> 7,Trans otter 2 Company Name U.S.EPA 10 Number <br /> 8.DesItinated Fadfity Name and Site Address <br /> Glean Harbors Aragonite,LLC U.s.EPAIDNamber <br /> 11600 North Aptus Road U DO81652177 <br /> Grantsville,UT84029 <br /> Fadlil>rs Phone: 435-8B4-81 OQ <br /> ga, gb,U.S.DOT DescdpHon(including Pmpar Sbfppirq Name,Hazer]Class,ID Numbe 7Q.Containers it.Tata! 12.Ualt <br /> HM and Pacing Group(ifany)) No. Type Quantity W1J1101. 13.Waste Cartes <br /> o fon-RCRAHazardous Waste Liquid(Specfrrtens in Formafln) <br /> 51 <br /> (9 <br /> 3. <br /> 4. <br /> 14.Stadol Handling]as <br /> lrucNons and Add'€6onal fnformauon p83698 Q )55212 <br /> 1)CFI10R6a94 <br /> Cantraat retained 8ygenerratar confers agencyRUM orilyon initial transporter to add or subs6luie additional transporiors on generalors behalf. <br /> 16. GENERATOR,sloFFEROWS CERTIFICATION:[hereby dedaro that fhe omtents of this k)onsignmard arefuily and accurstelydescribed above by the prapershipplog name,and era ciasslfied,packaged, <br /> marked and labeiudlplacarded,and aie In an raspec[s in propercvndifoh far transport aoamdlrg to appliabla internatlonafa fonalgovernmental regulations.If export shipment and f am the Pthwy <br /> Uportor,I certify&at the caoterlts Offt consigameni conform to the leans of the atlached i_PAAduwwledgmentof con <br /> I certify that tho waste minimization s identified In 40 262.27(2)(if I am a large quantily generator)ar m a srn 'quantity ge (00 Is true. <br /> GeneratodslOgerorsl�rinledlTypedName - Et <br /> 4 Day Year <br /> —j 16.international Shipments <br /> ❑rnpurl to U.S. ❑Export from U.S. of entrylexit: <br /> Transporter signature(for expodsonly): Dale feav rig ,.: <br /> 17.TramporterAckriodedgment of Retelido!Materials <br /> Transporter 1 PdnteitTyped Nana Signature <br /> Month 'Day Year <br /> TranspoRer2PrintedlType...... / v /V l <br /> 5gnalure Monty <br /> thh Da Year <br /> 18.Dlscrepmul y <br /> 182.Discrepancy indication Space ❑quanfry ❑ <br /> Type F411d ❑Partial Reject on ❑Full Releceon <br /> 18b.A1lemale Facility(or Generatar} Manifest Raforence Number, <br /> Zi U.S.EPA 10 Number <br /> U <br /> FacifitysPhune: <br /> LOU 18c.Signature ofAltemale Facility for Generator) Month Day Year <br /> F-. <br /> 0 €g.Hazardous Waste Report Management Method Codes(i.e.,codes lorhazaMous waste treatment,disposal,and racycfirvf systems) <br /> �l 1 j Z. 3 4. <br /> UD <br /> + 20.Designaled Facility Ovmeror Operator:Cerdficatlon of recelpl 01 hazardous materials covered by the manifest except as Acted in Item 18a <br /> Pdill yped Name , Sig f r Month Day Year <br /> LAhk <br /> EPA Form 8700-22(Rev.i2 ) Previous editions ere absafefe, <br /> ESIGNATED FACILITY TO EPA s o-MANIFEST SYSTEM <br />