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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21•Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) CAL000456484 2 022831221JJK <br /> 24.Generator's Name <br /> LODI UNIFIED SCHOOL DISTRICT MAINTENANCE&OPERATIONS <br /> Number <br /> 25, Transporter 3 Company Name RUST AND SONS TRUCKING INC CAR000187922 <br /> EPA ID Number <br /> 26,Transporter 4 Company Name NORTH STATE ENVIRONMENTAL INC CAR000206086 <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30,Unit 31.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WtNol. <br /> ❑ <br /> { <br /> L_ <br /> II <br /> ❑ !E <br /> i <br /> 1 <br /> 0❑ <br /> � � 1 <br /> Z I _w <br /> i <br /> I <br /> ❑ _ - �- I <br /> 1 <br /> pf! <br /> ❑ I ' <br /> t <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter 3 Acknowledgment of Receipt of Materials <br /> w Prinledrryped Name Signature Month Day Year <br /> 0 DAVID WICKERMAN DAVID WICKERMAN 03 18 2021 <br /> a. <br /> z 34.Transporter 4 Acknowledgment of Receipt of Materials <br /> Pdntedfryped Name Signature Mon-1ay ear <br /> ROBIN BYBEE ROBIN BYBEE 103 19 2021 <br /> 35.Discrepancy <br /> J <br /> U <br /> a <br /> LL <br /> Lu <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> rn <br /> w <br /> v <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete, DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />