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f.+ "t- S (f . 0 ¢tet :1 2 <br /> n22ti39 SC PPW 12/16/2008 <br /> Please print or We.(Form designed for use on elite(I2•pitch)typewriter.) • Form Approved.OMB•No.205D-0039 <br /> UNIFORM HAZARD9US 1.Generator ID Number i I 2.--Page 1 of 3.Emergency Response Phase 4.Manifest Tracking Number--- <br /> WASTE MANIFEST ICA D 9 9118397-5, 1 (OW)483-3719 00220"' 6 L <br /> T.Ge neratots Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Stockton Unified School District` <br /> x.944 Ns Et Phial Drive 1932 It.El Pinal Dare <br /> Stockton.CA:95205 Stockton.CA 95205 <br /> : GeneratoesPtnne:(2091933•.7045 ATfN:Butch Schrnidt <br /> .,ransporier 1 ompany Name U.S.EPA ID Number <br /> G an arbors Enrironlmtantal ices Inc MAD 0 33`3 2 2 2 5 0 <br /> 7. ran 2 pan ame U.SA <br /> 4zma <br /> 6. ed 8 ame and Site Address U.S. P D umber <br /> Clean Harbors AraeFonite LLC U T D 9 8 2 5 5 217 7 <br /> 11600 NorthAotus Road , <br /> Grantsville.UT 54029 <br /> Fadit es Phone: (43518 100 <br /> ger 9b.U.S.DOT Description(including Proper Shing Name,Hazard Class,ID Number, 10.Containers 11.Total 12 Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No, Type Quantity Wt.NOI. <br /> (17 1-U1111950.WASW AE LS, 331 U075 U121 <br /> x` i (TRICHLOROMONGRUOROMETHANE 0 Q i OF 00039 P <br /> DMLORO0I1FLUOROMETHANIE1.2.2.(83 ti <br /> z I z.Itkf 1 MFMt:iNF�1 f(?It¢rl mx¢[:,N A R. 311 <br /> (DAMPHETANNE.METHYLPHENIDATE).6.1.PG 11 0 O i D F 0 0 O e P <br /> 3.UNi85i.MEDICINE.UQUID.TOXIC.N.O.S.. 313 t r <br /> C (EPIPEN).6.1.PG Ins. °1` 001 O F < 00020 P <br /> ) s <br /> 4. a <br /> ` 14.Special Handling Instructions and Additional Information , <br /> .1_50048205-2 126 1X15 <br /> sd. RC ;� < LT0#151 1X5 <br /> ,!4CCRX 151 1X5 <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 dassfied,packaged, <br /> marked and labeledfplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulators.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of M consignment oonforn to the terns of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement iderrfit'ied in 40 CFR 262.27(a)(if I am a large quantity,generator)or(b)(d t am a small quantitytot)is true. <br /> nerato ros Pdriteilayped Name Month Uay Year <br /> t W. s1c,104//J .7. Id LA.r re ,e'c 01` 2IR IN <br /> J 16.tntematignal Shipments <br /> [= S ❑Import to U.S. ❑Export from U.S. Port of enlry/eoat <br /> Transportiir ' aturefoe o Data leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials. <br /> Transporter 1 PrintedfrypedName signature Month -< ear <br /> 0 Mgt Al i 101 128 109- <br /> Z Print Name°•' Ct . <br /> Q t <br /> 16;Discrepancy <br /> 185 Discrepancy tndxx8an Space 4Z 9 - <br /> 0 Quantity ❑Type ❑Residue Partial Rejection . <br /> \ �Fup R*cgon <br /> Manifest Reference Number. --' <br /> 1'8b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> .41 Facili s Phone: <br /> W 18c Signature of Alternate F ty(a Generator) ` -r Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(Le,codes for hazardous waste treatment,disposal,and recycling systems) <br /> ® hok <br /> 1. 2. 3. 0 r 14. w <br /> F. <br /> . Eb-�6 - I <br /> 20.Designated Facility Owner or Operates n of receipt of hazardous mateffalsweled by the manifest except aj not Item 18a <br /> ! Pri Nam Skjna DaYe <br /> ;:� <br /> r <br /> EPA Foran 8700-22(Rev.3-05) Previous editions are obsolete. W pv ISTME(IF REQUIRED}. <br /> 10538.2018 <br /> I <br />