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Please print or type. Farm 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 024625754JJK 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 R AMOS 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.RQ UN1203,WASTE GASOLINE 3,PGII(D001) D018 ID001 XO 1 DM 5 G - 1331 w 2. 3. 4. 14.Special Handling Instructions and Additional Information Line 1: 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, 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 EPAAcknowledgment 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. Generators/Offero s Printed/Typed Name Signature on ay ear PETE LILIENSTEIN PETE LILIENSTEIN 02 1 02 1 2023 J 16.International Shipments F El import to U.S ❑Export from U.S. Port of entry/exit: Z Transporter signature for exports only): Dale leaving U.S.: Ll 17.Transporter Acknowledgment of Receipt of Materials W Transporter 1 PrinledlTyped Name Signature Monthay ear 00 HEATHER BAUGH HEATHER BAUGH 02 02 2023 U) Transporter 2 Printed/Typed Name Signature Month Day Year Q XAVIER CRUZ XAVIER CRUZ 02 06 2023 18.Discrepancy 18a,Discrepancy Indication Space Quantity Dype ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 181b.Alternate Facility(or Generator) U.S.EPA ID Number J C5 LL Facility's Phone: w 18c.Signature of Altemate 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) G 1, 2. 3, 4. 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 ALMA VACIO ALMA VACIO 02 15 2023 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM