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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.ManifTracking Number WASTE MANIFEST C A L 0 0 0 0 4 0 9 0 0 S 877)818-0087 051519592 VES S.GonaraWs Name and AWling Address FACILrMS PLANNING,BUTCH SCH General&!S•se Address fif different than malling address) FRAMCUN IEGN SCHOOL 300 N GERTRUDE ST 1944 EL PINAL DR STOCKTON,CA 9-';2t5 STOCKTON,CA 95205_2548 Generators Phone: � 6.Transparler t Company Name UA-EPA Ip Ntmther VISOLIA ES TECHNICAL SoLurlOm N J D 0 S 0 6 3 1 3 6 9 7.Transporter 2 Company Name U.S,EPA ID Number 8.Designated Facility Name and Site Address U.B.EPA ID Number VEOLIA ES TECHMCAL SOLIMONS, L.L C 1125 HENSLEY STREET F4040 Phone: RICHMOND,CA 94801 C A T 0 8 0 0 1 4 0 7 9 ga 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Numbe. 10_Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. cc X 1. NA3077,HA7TARWUS WASTE,SOLID,n oz.,(LEAD, D00S Q IRON" n m 1 D F 80 P 181 c� ( d� W 2 l� k� T 0 d A J fit[ 14.Special is^.dfir �d ESTE A- CSarlIlxctrlebunedbygwv%br confens _._.,_--- ti�tts*sStxfge!l�tat>u�s[ he1f 1)ERQ:171 W:39671, 4 - 15 GENERATOR t are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and h ___.�--�--•------ — -- icable inlemaGonal and national governmental regulations.If export shipment and I am the Primary Exporter,I cel uledgment of Consent. I certify that lh nerator)or(b)(if I am a small quantity generator)is true Generators/Offeror natL a Month Day Year 1 .Inzzrnalianal pmonts F— ❑Import to:J.S. Export from U S. of entrylexit: ? Tmnsporter edgnature(for exports only): ate leaving U.S: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PnnWITyped Name Signature Monm Day Ym jgA Z r. . 7ypedName signature Month Day Year H 18 Discrepancy 18a.Discrepancy Indication Space Quantird ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection l,Sanikst Reference Number 18b-Alternate Facft(or Generalorl 5.3 EPA ID Number J_ V L Facility's Phone w 18c Signature of Mlemale Facility fon Generator) tdonth Day Year Q Z N19.Hazardous Waste Report Managernent Method Codes(i.e.,codes for hazardous waste treatment,d4poSal.and recycling systems) LU 1 2 3. 4. 20-Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the menifesl except as noted in Ilem 18a dS Along A 41 rg EPA Form 8700-22(Rev-12-17) Previous editions are obsolete. DESIGNATED FACII-ITY TO,E'FA's es-M!,ANirESi S'yS EFS;