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PiGTeSLk <br /> (�h6BEi1-2c1 3&S2308 2-3-ZD <br /> Please print or type. <br /> Form Approved.OMB No.2050-OU, <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WAKE MANIFEST Ct�R000285932 1 (B77) 577-2h6'.+ 00 0312691 DAT <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> CITY W (MUUTY OF SFFUC TRACY FACILITY CITY FA CODUIT OF SFPUC TRACY FOCILITY <br /> 1390 WRKET STREET, 5TE 119 9009 TEST VER'MUS ROAD <br /> Generator's Phone: SAN FR04CISGO CA 94102 (415}252-3977 TRACY CA 95377 <br /> 6.Transporter 1 Company Name rr U.S.EPA ID Number . <br /> 7.Transporter 2 Company Name - U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> 21ST CEdRWRY EUYIROtt!(El(TAL flf'riR 601EUT OF REYA09, LLC <br /> 2095 9ealands Drive East <br /> FacilitysPhone: FERNLEY, UN 99409 (I75) 575-2150 NVD980895338 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WLN0I. <br /> 1. ..i it ��.� .' ;i4}1i Ci:3`�`t:s.�tl, it'i <br /> R' DF <br /> o X <br /> t ills 1 1 1pJ1 <br /> tz 2. X1,1 d 3i '!5 ii''t•i R{ J�ftTc SU._»i i;,S d t'tiL kU f) ) <br /> � X �O) DF l�D F' <br /> 3. N3 4 Vila L C`R9 S ' J, R 1 :, INMW W c, r. . . ll912 u 4 B2 <br /> X (HYDROCHLORIC ACID, SODIUfl ARSEHITE) 9 PGII RQ(DD02) 00 DF P <br /> 4. NIR34i i:irct�x t' S1 , �a�5d_ . TT; ;itis 1 FELL F j51 <br /> X I'6III �D( DF r 2 F <br /> 14.Special Handling Instructions and Additional Information <br /> Liz (2)aaa"`iir;; "-t;i (2) 643335-01 - Eti5(15411 SOK91 HTFOCHiOWTE 13) RCCCSFFLUN-43 - <br /> ER6(1541 FLUORIDE AUALYSIS (L (4) RCCCSFDIROGS-92 - E96(1711 RAGS Y1TH DIESEL <br /> I-) 1 X X-s-- ) I A, C- <br /> 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, <br /> marked and labelediplacarded,and are in all respects in proper condition for transport according to applicable intemational and national governmental 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 attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(dl app small quartV generator)is We. <br /> Generatoes/Offerofs Print ped Na Signature Month Da Year <br /> 16.International Shipments <br /> El �Q <br /> Import to U.S. ❑Export from U.S. Port of entry/exit <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> UJI <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> a A r; '�„ 3 oZ✓ <br /> Z Transporter 2 Printed/Typed Name Signature Month Day Year <br /> t- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> F 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> U <br /> tall. Facility's Phone: <br /> W87 Signature ofAltemate Facility(or Generator) Month Day Year <br /> 4 <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p i. 2. 7w4l <br /> 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as nde Item 18a <br /> Printedrryped Name ature Month Day Year <br /> c L 'q <br /> EpA Form 8700-22(Rev.12-17) Previous editions are solete. DESIGN6XD FAGOfqY TO EPA's e-MANIFEST SYSTEM <br />