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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest TrackingNumber <br /> WASTE MANIFEST CAD981466023 2 800.633-82531000336695 DAT <br /> 5.Generator's Name and Mailing Address a UbICk Generator's Site Address(if different than mailing address) <br /> UnKersity Of The Pacific University Of The Pacific <br /> j 3601 Pacific Ave 3601 PadfIC Ave <br /> Stodkton,CA 95211 Stockton,CA 95211 <br /> Generator's Phone: 209-946-2908 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Ingenlum (Saaamento)(****ERI PHONE-Gust ID#8766-0004****) CAR000179747 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> Ingenlum (fuvfllpitasX****ERI PHONE-Gust lD#8766-0002****) CAR000179747 <br /> 8.Designated Faciliry Name and Site Address U.S.EPA ID Number <br /> Covanta Environmental Solutions LLC INR000127621 <br /> 5625 Oid Porter Rd <br /> Portage,IN 46368 <br /> Facility's Phone: 260-240-2461 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wtivol. <br /> 'Non-RCRA Hazardous Waste Liquid(waste oil) 223 <br /> c <br /> 0 qjr C <br /> Z 2. <br /> W <br /> 3. <br /> 4. <br /> 114.Special Handling Instructions and Additional Information D107273 SO 166892 <br /> ).1)41465962 <br /> k fl-Co"ntractretained bygenerator confers agencyauthodtyon Initial transporterto add or substitute additional transporters on generators behalf. <br /> 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, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to ft terms of the attached EPAAckmowiedgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity gene or(b)(d I am a small quantity generator)is true. <br /> Gen or's/OfferVs Printed./yr <br /> Tame y Sfana Month Day , Year <br /> LC QA <br /> ^( <br /> 16.Intemational Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of /exit. <br /> Transporter signature(for exports only): Date lean ng U.S.: <br /> rY 17.Transporter AcknoWedgment of R pt of Materials <br /> OTra n yped a Signe Month Day Y <br /> rk <br /> rn Transporter 2 Printed/Typed NamEr Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> LL Fatality's Phone: <br /> 1Be.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18e } <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e•MANIFEST SYSTEM <br />