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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 CAL000456484 2 916-371-5747 022831221JJK 5,Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) LODI UNIFIED SCHOOL DISTRICT MAINTENANCE&OPERATIONS 880 N GUILD AVE LODI CA,95240 Generator's Phone: 209-331-7186 6,Transporter 1 Company Name U.S.EPA ID Number RAMOS ENVIRONMENTAL SERVICES CAD044003556 7,Transporter 2 Company Name U,S.EPA ID Number ECOTRANS LLC CAR000245050 8.Designated Facility Name and Site Address U.S.EPA ID Number PACIFIC RESOURCE RECOVERY SERVICES INC CAD008252405 3150 EAST PICO BLVD LOS ANGELES CA,90023-0000 Facility's Phone: 800-499-7145 9a. 91b.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 Wt./Vol. 1.UN1263,WASTE GASOLINE,3,PG II D001 ID018 O X 1 DM 20 G — 13 — 1— 1331 Z 2. W f 0 3, 4. 6 i I 14,Special Handling Instructions and Additional Information Line 1: 15, GEN ERATOR'SIOFFEROR'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 a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator's/Offerors Printed/Typed Name Signature on ay Year PETE LILIENSTEIH PETE LILIENSTEIH 03 05 2021 16.International Shipments 1-- Import to U.S ❑Export from U.S. Port of entry/exit: z Transporter signature for exports only): Dale leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Prinledrfyped Name Signature Month Day ear 0 ILLEGIBLE ILLEGIBLE 03 05 2021 CL QTransporter 2 Printed/Typed Name Signature Month Day Year JAVIER CRUZ JAVIER CRUZ 03 11 2021 t- 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 U LL Facility's Phone: w 18c.Signature of Allemate Facility(or Generator) Month Day Year Q Z N19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLI H061 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 ELAINE HUIZAR ELAINE HUIZAR 03 1 22 1 2021 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete, DESIGNATED FACILITY TO EPA's 9-MANIFEST SYSTEM