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Please print or type. Form Approved.OMB No.2050.0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 14.Manifest Trackin Number WASTE MANIFEST CAD981456023 2 800-633-8253 00 0 2 4 7 4 2 5 DAT 5.Generators Name and Mailing Address ATTN:Mike Ubick .Generator's Site Address(if different than mailing address) University Of The Pacific UniversityOfThe Pacific 3601 Pacific Ave 3601 Pacific Ave Stockton,CA95211 Stockton,CA 95211 Generators Phone: 209-946-2908 6.Transporter 1 Company Name U.S.EPA ID Number Ingenium Sacramento ****ERI PHONE-Gust ID#8766-0004**** CAR000179747 7.Transporter 2 Company Name U.S.EPA ID Number Ingenium (Milpitasx****ERI PHONE-Cust ID#8766-0002****) 1. CAR000179747 B.Designated Facility Name and Site Address U.S.EPA ID Number Recicladora Temairyde Mexico,SA de CV MXC130619001 Carr.Fed.No.2,Mex--Tij,KM 121 San Pablo Tecate,BC,Mexico, CP21530 Facility's Phone: 619-270-9453 Chemtrec 2417#EMERGENCY(800)424-9300 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Contalners 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity WI.Nol. 0 1'UN1993,Waste Flammable liquids,n.o.s..(ethanol,toluene),3,II Q001 F003 005 0 X DOTERG#128 ©© � Q 1047 ( 331 2'NA3077, Hazardous waste,solid, n.o.s.(lead nitrate, methanol),9, D006 D007 D008 X III DOT ERG#171 00 W F003 F005 352 3. 4. 14.Special Handling Instructions and Additional Information D90971 SO 169203 - 1)R18-21060 2)R18-21062 (yXG,(ig) 5S44 Primary Exporter:TemarryRecycling,Ino.AOC Solvent020514 E18001 Aqueous 020526 E18001 Solid 020530 E1800 15. GENER.ATO 'SIOrFEROR'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 international and national governmental regulations.If export shipment and I am the Primary 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 minimization statement identified in 40 CFR 262.27(a)(if I am @ large'quantity generator)or(b)(ifI am a small quant generator)is true. GeneratorslOfierors Pdnted1T d Name Si Month Day Year V 640 ,j16.Int mational Shipments F, ❑Import to U.S. Export from U.S. Port of entry/exit: Am z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Uj O Transporter)Printed/Typed Name Signature Month �O Y Year C aTransporter 2 Printed/Typed Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J V ra Facilitys Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a , z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 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 Pdntedrryped Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM