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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000456484 1 916-371-5747 100053196ELC 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 8.Designated Facility Name and Site Address U.S.EPA ID Number RAMOS ENVIRONMENTAL SERVICES CAD044003556 1515 S RIVER RD. WEST SACRAMENTO CA,95691-0000 Facility's Phone: 916-371-5747 9a. 9b.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 WUVOI. 1.non rcra hazardous waste solid(oil,debris) ) 0 1 DM 200 P -- — — 352 Lu 11 W 2 I i 3. j i� i 4. I I I i 14.Special Handling Instructions and Additional Information 9b-1)profile# erg#171 E.R.contractor:Ramos Environmental handlers should be trained and use approved ppe;Line 1: 15. GENERATOR'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/Offeror's Printedrryped Name bignature Month Day Year Pete Leileinstein Pete Leileinstein 03 05 2021 -J 16.International Shipments ❑Import to U.S ❑Export from U.S. Port of entry/exit: Transporter signature for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials 1i Transporter 1 Printed/Typed Name Signature Month Day Year a john villanueva john villanueva 03 08 2021 QTransporter 2 Printed/Typed Name Signature Month Day Year H 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 C,> LL Facility's Phone: w 18c.Signature of Allemale Facility(or Generator) Month Day Year Q Z as19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. 3. 4. H141 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a rj tedrTyped Name Signature Month Day Year o hnn villanueva john villanueva 03 08 2021 EPA Form 8700-22(Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA'S e-MANIFEST SYSTEM