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12- itch ewriter. Form <br /> for ibIb on elite.( P )h P ) 2,Page 1 of 3.Emergency Response Phone Manifest Tracking Numberoved.0MB Na.2050 0033 <br /> ,Ganeralar l0 Number <br /> GgLD00273993 800-633-82531"000240179 ®AT <br /> ddrass ATTN:AnthonyFlores Generator s Site Address(rfdifferent than mailing address) <br /> i ,� jradl District TUSD-Mst High School <br /> (u <br /> ti i t1 775 W Lowell Ave <br /> Tracy,CA95376 <br /> pName U.S.EPA ID Number <br /> S -c0 rr ento)(——ERR PHONE-Gust ID#8766-0004"1") CAR000179747 <br /> Name U.S.EPA ID Number <br /> errs Enuronm ental Services M4D039322250 <br /> Narae and Site Address U.S.EPA ID Number <br /> tiers Pia unite, LLC UTD981852177 <br /> ofth hs�oad <br /> (fir UT.8 <br /> L 4029884-8100 <br /> SDOT QesaipLIM[urdudxxt Proper Shipping Name,Hazard Class,ID Number, 10.Conte ours 11.Tafel 12.Unit <br /> _ P(tiany)) - No. Type Quantity SYVt„Vd. 13.Was6CodEs <br /> or <br /> "RCFZAHazardous baste Liquid(Specimens in Palmetto) 551 i <br /> Dr <br /> A3077, Hazardous waste,solid, n.o.s.(silver,acetone);9,NJ 3352 D005 D011 <br /> SOT ERG#171 <br /> j � "70 F003 <br /> ,lm <br /> 77 <br /> 4. <br /> r <br /> 4,Spaclal Handling Instructions and Additional Information <br /> D73045 SD 122911 <br /> I)CH1016594 2)CH818285 <br /> Comtraet retainad by generator eonfeis agency ai thcidty on inifial transporter to add or snbstatute additaonal transporters angeneratafs behalf <br /> 15. GENERATOR'SfOFFEROR'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 labeledlplacarded,and Are in all respects in proper condition for transport accarding 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 EPAAcknowledgment of Consent. <br /> I certify,that the waste minimization statement Identified in 40 CFR 282.27(a)(if l am a large quantity generator)or(b)(if[a malt quantity generator)is true. <br /> Gen Olferor's Printed ped Name Signature Month Day Year <br /> G c�d <br /> ....r .IntemaGoVipments <br /> ❑Import to U.S. LlExport from U.S. Port of entrylexiL•Transporter re(for exports only): Date leaving U.S.: <br /> 17.TransporierAcknowiedgment of Receipt of Materials <br /> OTransporter 1 Printedfiyped Name Signature Month Day Year <br /> n, d`+ <br /> 11-20 1 <br /> Q Transporter 2 Pdntedlryped Name Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑ ❑Partial R*ction Full Rejection <br /> ❑Type Residue t ❑ <br /> Manifest Reference Number. <br /> 15.Aflemale Facility(or Generator) U.S.EPA ID Number <br /> ti <br /> Facilitys Phone:, <br /> LOU 18c.Signature-ofAllemale Faci#ity(or Generator) Month Day Year <br /> 9.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycting systems) <br /> 2. 3. 4. <br /> 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedffyped Name Signature Month Day Year <br /> .PA Farm 8700-22(Rev 3-05) Previous editions are obsolete. •DESIGNATED FACILITY TO DESTINATION STATE (1F REQUIRED) <br />