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UNIFORM HAZARDOUS 1•Genemfar ID Number �7ATage 1 of 3.Emergency Response Phone 4.Manifest(TI ckin( uu]mb(eerr <br /> =MANIFEST CAL000273993 800-633-825300 0 1 rJ 9 6 77 , DAT <br /> 4GeneralorsName and MailingAddress /�'�'(! :Gar Krebbs <br /> Genorator'sSiteAddress(rfddferentthan mailing address) <br /> Tracy Unified School District West High School <br /> 1875 W Lomli Ave ` 1775 W LoWell Ave <br /> Tracy.CATracy,� �6 Tracy,CA 95378 <br /> Generator's Phone: T, 'All <br /> U.S.EPA ID Number <br /> 6.Transporter 1 Company Name <br /> Ingonium (Sacramento)yC***ERIPHOL4F-ruslD#8yc6-0004****) CAR000 <br /> gMi�xk Z <br /> 7,Transporter 2 l <br /> mpanyName U.S.EPA[DNurnUer <br /> 8.Desi nated Facility Name and Site Address; s- U S.EPA ID Number <br /> Lglean Warriors.San Jas ;LLC alo ' <br /> 1021 Bertyessa Road <br /> San Jose,CA95133 <br /> Facilil}�s Phone: �f75 X41-Q982 <br /> ga 9b.U.S.DOT Description(Including Proper Shipping Alamo,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.1Vol. <br /> 1-UN1T60,Waste Corrosive liquids,n.os.(silver,hydrochloric acid), D002 DON Doll <br /> F003_ .792 <br /> z 2. <br /> UU <br /> 3. <br /> 4. <br /> f.Spec-sal Handling Instructions and Additional Information r <br /> Document D52757 Sales mer 77983 <br /> )lay Dol-ERG#1 54 <br /> 15. GENERATOR'SIOFFEROR'S CERTIF[CATION: 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 labeled/placarded,and are In all respects in proper condition for transport according to applicable ialemationatand national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents ofthis consignment conform to the terms of the attached EPAAcknowledgment 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)(ff I am a small uantily generator)istrue. <br /> GeneratoesfOge <br /> rsF nledllyped a Signature r` Month Day TYear <br /> -,r7S Pi 01-I I? rr cry 12- 1zl 7 <br /> -J 16.International Shipments <br /> ❑ Port of en Import 10 U.S.• ❑Export from U.S, bylexif: <br /> Transporter signature(for exports only): Dale leaving U.S.: <br /> LU t7,Transporter Acknowledgment of Receipt of Materials <br /> amiMonth Day Year <br /> Z Transports 2 intedlTyped Name Signature <br /> 18.66repancy <br /> 18a.Discrepancy Indication Space <br /> Partial Rejection ❑Full Rejection <br /> Quantity D <br /> Type <br /> "-fulantfest Reference Number: -: <br /> t8 .Aiiorn(t Facility(or Generator) gg= U.S.EPA ID Number <br /> b <br /> rQi Facilitys�Phone: - - <br /> 18c.Signature ofAlternate Facility(or Generator) Month Day Year <br /> a _ <br /> z s, <br /> Hazardous Vaste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> IF <br /> 2, 3. 4, _ <br /> td- <br /> 20.Designatedity Owner or Ope tor:Cenificat' of receipt of hazardous materials covered by the manifest a as noted in Item 18a <br /> Printedflyped Na Signet- Ma ih a <br /> EPA Form 8700-22(Rev.3-0 Previous editions are obsolete. ;- s... DE 11lATEt7 FACILITY 70 DESTINATION STF6TE iPREQUIRED} <br />