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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 4. Manifest Tracking Number WASTE MANIFEST CAD981456023 2 800-633 -8253 00024746 5 DAT 5, Generators Name and Mailing Address ATTN : Mike Ubick . Generator's Site Address (if different than mailing address) University Of The Pacific University Of The Pacific 3601 Pacific Ave 3601 Pacific Ave , Stockton , CA 95211 Stockton , CA 95211 Generator's Phone: 209-946-2908 6. Transporter 1 Company Name U.S. EPA ID Number in enium Sacramento * * ** ERI PHONE-Cult ID# 8766-0004* * ** CAR000179747 7. Transporter 2 Company Name U.S. EPA ID Number Ingenium ( MilpitasX* * * * ERI PHONE-Cust ID# 8766-0002* ** *) CAR000179747 8. Designated Facility Name and Site Address U.S. EPA ID Number Recicladora Temarry de Mexico , SA de CV MXC130619001 Carr. Fed , No . 23 Mex-Tij , KM 121 San Pablo Tecate, BC , Mexico , CP21530 Facility's Phone: 619-270-9453 Chemfrec 24/7 # EMERGENCY (800) 424-9300 ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12. Unit 13. Waste Codes HM and Packing Group (if any)) No. Type Quantity XNol. 0 1 . UN1993, Waste Flammable liquids , n .o.s,. (ethanol , toluene) , 3 , II 0001 F003 -005 X DOT ERGW128 © © a- DF 0 100 331 UJ 2' NA3077 , Hazardous waste , solid , n .o .s . (lead nitrate , methanol) , 9 , D006 D007 D008 X III DOT ERG#171 ® O 00 F003 F005 352 3. 4. 14. Special Handling Instructions and Additional Information D90971 SO 169203 1 ) R18-21060 2) R18-21062 (gyC%(a ) A 141 Primary ExporteffemarryRecyoling,fnc. AOC Solvent 020514 E18001 Aqueous 020526 E18001 Solid 020530 El 800 15. GENERATG 'SIO FEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name , at are classified; packaged, marked and labelediplacarded, 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 Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certily that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) ('dl am a small quantl generator) is true. Generator's/Offerors Printed/T d Name Si Month Day Year rn 6 ot Iva n) 16. International Shipments j_ ❑ Import to U.S. Export from U.S. Port of entry/exit: co08 z Transporter signature (for exports only): Dale leaving U.S.: W 17. Transporter Acknowledgment of Receipt of Materials F Transporter 1 PrintedlTyped Name Signature Month Day Year co /Zo� Z Transporter 2 Printedffyped Name Signature Month Day Year r 18. Discrepancy 18a. Discrepancy Indication Space ❑ QuantityType ❑ Residue ❑ yp El Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Altemate Facility (or Generator) U .S. EPA ID Number J U ra Facility's Phone: LOU 18c. Signature of Alternate Facility (or Generator) Month Day Year a , z U) 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 Printed/Typed Name Signature Month Day Year EPA Form 8700-22 (Rev. 12- 17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e• MANIFEST SYSTEM