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Please print or <br /> type, Form Approved.OMS No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 of 3.Emergency Response Phone A,Manliest Tracking Number <br /> WASTE MANIFEST 7 , 01228-3760 FLE <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if ci ferent than mailing address) <br /> Manteca UnOeed School 101mblet (S#&Tal HO) <br /> 17:0 Thomas St <br /> Manteca, CA 95337 <br /> Genneratces Phare: <br /> 6.Transporter 1 Company Name U.S.EPA M Number <br /> Adiiiar►ced Chanrcal Tran%p Inc.10 A ACTEWRO (�ARC0007LI540 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8,Designated Facllity Name and Site Address U.S.EPA ID Number <br /> US EN&*Qda tinc <br /> PO Baoc�B �}r� 9x,11 Mlles S &ear•,y NVT330310" <br /> Beaty, NV bia <br /> Facilitys Phone: 775-5 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,hazard Class,ID Number, 10.Containers 11,Total 12.Unit 13.Wane Codes <br /> HM and Packing Group(If any)) No. Type Quantity wuVol. <br /> "NA3082, Hazardous waste,liquid,n.o.s. (Photo SIher Y p {JOt 1 <br /> 54 1 <br /> F- x Sntuticm) , 9, PG1H <br /> I <br /> 3. <br /> i <br /> 4. <br /> i <br /> 14.5peaal Handling Instructions and Additional Iniomlation v Prosed NJ—tW 1&4473 DDCUT", <br /> 1)ER00171, 07013TI50-271 MAUIE/V <br /> 15. GE NERATOR'SfOFFEROR'S CERTIFICATION: I hereby declare that the contents of oris consignment are fully and accurately described above by the proper shipping name,art are classified,packaged. <br /> marked and Iabeiedlplacarded,and are in all respects in proper condition for transport according to applicable intemationaland national govemmental regulations.If export shipment and I am the Primary <br /> Exporter.I certify that the contents of this consignment conform to the terms of the atrac tied EPA Acknowledgment of Consent <br /> I certify that the waste minimizanon satement identified in 40 CFR 262.27(a)(01 am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generator'sQfferors Printecirryped Name Signature Month Day Year <br /> 16.International Shipments <br /> r-- 11 ( / <br /> Import to U.S. ❑Export from U.S. Port of entryexd <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> W 17,Transporter Acknowledgment of Receipt of Materials <br /> W Trartsp� Ank <br /> Ced�Typed Name Sig Month Day YearC i - " tr c"a r} r� , <br /> Z Trbrts rter 2 Pnntecigybed Name Sgnature V It Nil <br /> Day Year <br /> F- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Pariial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 19b.Ahemale Facility lot Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Fak•.ilitys Phone: <br /> 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> W 1. 2. 3. 4. <br /> 2D.Des gnated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Ba <br /> Printedlryper Name Sgrtature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete, <br /> GENERATOR'S INITIAL COPY <br />