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Please print or type. \ `' /"' "1 Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Trackl Number WASTE MANIFEST CAD981456023 2 800-633-8253 OQ O Z 7 4 2 7 DAT I 5.Ge tpr's Na e a Iing dreii Gee tot's Sited diff nt tb mailing address) `Unlverst +r to act is - nlversr jr` l9 act Ic I( 3601 Pacific Ave 3601 Pacific Ave Stockton,CA95211 Stockton,CA95211 I. Generator's phone: 209-946-2908 r i 6.Transporter 1 Company Name U.S.EPA ID Number Ingenium Sacramento)(****ERI PHONE-Cust ID#8766-0004****) CAR000179747 i 7.Tra sporter?Compa N me U.S.EPPgql��tt��u e j �ngenium ��tilfpltao****ERI PHONE-Gust ID#8766-0002****) ISAW0479747 ��pi{�� g��.. es i I 8.De9eali hi&1'pOtS nPrl�egOn tib,LLC, U.S.EPA ID Number - 1 11600 North Aptus Road UTD981552177 Grantsville,UT 84029 j Facility's Phone: 435-884-8100 9a. 9b.U.S.DOT Description(including,Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No, Type. Quantity Wt.Nol. 1-UN1323,Waste Flammable solids,organic,n.o.s. methanol gel , 331 D001 o X 4.1 , II DOT ERG#133 I z 2.UN 7 ,Waste Corrosive liquids,n.o.s. Hydrochloric acid),8, II 792 D002 D005 X DOTERG#154 �►" 1 P D011 F003 3.UN1873,Waste Perchloric acid [with more than 50 percent but not 551 D001 D002 X more than 72 percent acid,by mass],5.1 (8),1,RQ DOT ERG#143 i 4.UNZU31,Waste NMIC act [other than red turn.Ing,With at least ( 1551 -NOT X percent,not more than 70 percent n We acid],8(5.1),II,RQ DOT I ERG#157 6 j 14.Special Handling Instructions and Additional Information169203 ( 1) H1 10075 2)CH101 149 3)CC66984-SP LRCTO/UPS-1/05G H2 4)CC66984-SP LCCRAAJPS-2/05 H2 by gen tarot oonfers ag Contract rained encyauthorttyon initial transporter to add or substitute additional transporters on generators behalf. i 15. GENERATOR'S/OFFEROR'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, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable internationaland national governmental regulations.If export shipment and I am the Primary i Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent, I certify that the waste minlmizatioh statement identified in 40 CFR 262.27(a)(if I am a large quantiiy generator)or(b)(If I am a small quantity generator)Is true. Generator s/Offerors PdntedlTyp me Month Day Year 2,l t 16.International Shipments F-- ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.TransporterAcknowledgment of Receipt of Materials 0. . E2 Transporter 1 Printed/Typed Name,,---- �� Signature Month Day Year a O L� A C191 Ill Z Transporter 2Pdnted/rypedName Si nature g Mohth Day Year r 18.Discrepancy. 18a.Discrepancy Indication Space Quantity ❑Type Residue ❑Partial Rejection ❑Full Rejection 18b.Alternate Manifest Reference Number:Facility(or Generator) U.S.EPA ID Number v • LL Facility's Phone: C3* 18c.Signature of Alternate Facility(or Generator) Month Day Year z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) I 1 2. 3. 4. 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pdnied/Typed Name Signature Month Day Year i EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM