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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 Tra�cjking Number WASTE MANIFEST . 0 ', - 7466 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Sutter Macy Gottftnutflity Haspital Sutter Tracy Gonwwndy r,tta�i7 { 1410 N Tracy SM 1420 N TracyBM Truy, CA 85376 Tracy, CA 8376 Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number INkS Emlitw It;Mat 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number US ECOLOGIC NEVADA Hvjy e ty,'NV S03Sevth of Beatty NVi33001 0 Facility's Phone: 775-553Q,203 ga. 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. 1 LIN 1851, t',ialste Medicine,liqusd,taxic,n.o.s. (BMj ^.1 X51 IM05 '� SULFAS). 6.1 , I ° �'.�U P W 2'NA3082, !',taste Hazaedan trastae~,liquid, n.o.s, (CHR{tt,A6.K 13S DN7 POTASSiuiw IMIDE), B ,0 3 Non-RCRA Haardow Vkste,Liquid au1Eend;f ammkiij 343 a�» P 4.NonrRCRAHa7ardWs Waste, Solid (Lime FArm) 352 14.Special Handling Instructions and Additional Information Documed:D276592 00701137750-411060 ERM S1 I X f s 3)070131570-31269 / x I Jr 211 0701377504M EROM 71 � �t S- 4)679127495-10590 /� p q 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 Printed/Typed Name Signature Month Day Year 1 I'j J 16.International Shipments 1:1 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 LU Transporter 1 Printed/Typed Name Signature Month Day Year CL z Transporter 2 Printed/Typed Name Signature Month Day Year H 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type El Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 181b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: C3 18c.Signature of Alternate 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. f 4. 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 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY