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designed far use on elite(12-pitch)typewriter.) Form Approved.OMB No,2050-0039 <br /> f.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 14.Man®s�ra €n�Ny�nbp,� ®�� <br /> p[1s CAL000273993 800-633-8253 i�a1'�J <br /> e d btailin Address 0 MS Generator's Site Address if different than mailing address) <br /> x Fifad.. c gaol usmct TUSD-VV School <br /> p—ell Ate. 775 W Lowell Ave <br /> Trac,CA 95376 <br /> hone' <br /> T1 pany Name U.S.EPA ID Number <br /> �rjum' pacramento)("***ERI PHONE-Gust iD#8766-0004****) CAR000179747 <br /> I bra t{ar 2 Company Name U.S.EPA ID Number <br /> can Harbors EnVronmental SerMces MAD039322250 <br /> 8 t7es afed F cr 1 Name and Site Address U.S.EPA ID Number <br /> ��ean rbors Sari Jose,LLC CAJ059494310 <br /> 1021 BerTyessa Road <br /> San Jose,CA95133 <br /> FacflilysPhone: 408-441-0962 <br /> 9a. 9b:U.S.DOT Description('mdudmg Proper Shipping Name,Hazard Class,ID Number, 1©.Containers 1t.Tafal 12 Unit 13.Waste Codes <br /> HM and Packing Group(d any)) No. Type Qwrdity Wtivol. <br /> o ?•UN2031,Waste 1}tiMC acid,8(5.1),lI DCT ERG#157 551 D0011 D002 <br /> TF- 1P <br /> LU <br /> ` r " t r. + t L <br /> X B ,II D <br /> 4. <br /> 14.Special Handling Instruc(ions and Additional In(armation D73046 SO' 122911 <br /> 1)2-01.40 1-CCRAANHS-11 G H2 2)CH818278 <br /> d <br /> Contract retained by generator confers agency aufhaaity.on initial tsmpox-ter to add or sab-stitute additional t--qmpo ers on genenatoz's behalf. <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fufly and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labtedlplacarded,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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowtedgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or{b aR quantity generator)is true. <br /> Generators! atsPrintedlF Name Signa Month Day Year <br /> 16.International Shi nts <br /> F— - .❑Impart to U.S. ❑&part fro ort of.hylexit <br /> z Transporter signature(for exports only): Date leaving U.S.: <br /> LW 17.Transporter Acknowledgment of Receipt of Materials <br /> .Transporter 1 Printedfryped Nam Signature Month Day Year <br /> n. <br /> 1.2-1&V Ile <br /> aTransporter 2 Pdnledrfyped Name gnu a Month Day Year <br /> tx <br /> F- <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space ❑ Quantity ❑Typel j <br /> ❑Residue ❑Partial Re oction ElFull Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> LOU 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling 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 /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev,3-05) Previous edilians are obsolete. DESIGNATED FACILITYTO DESTINATION STATE (IF REQUIRED) <br />