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©ood�.� oa <br /> Please print or type-('Form designed use on elite(12-pir'cl0 typ vdil Let) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1•Generator ID Number C o)e LO'f'?, 2.Page I of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> ►46.a ( h p0114�.4 VES <br /> WASTE MANIFEST C.L D Il I rj `� d 't 0 S Q4rgua �j' ?1 u15-1]031 <br /> 5.Generators Name and Malfing Address J014 SCR f G�j` Generator's Site Address(if different than mailing address) <br /> FRA2 L.I11 HICrH SCHOOL 300 N GERTRUDE ST <br /> i 944 EL PINkL DR STC)IC{TON, Ck 95215 <br /> STOCKTON, CA 9511015-2546 <br /> GeneratotsPhone: <br /> 6,Transporter 1 Company Name U.S.EPA ID Number <br /> VEOLIA ES TECHNICAL SOLUTIONS i'3 ] D 0 3 Ci 6 3 1 3 9 9 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address rE��rLLA ES TECHNICAL Sr LUTI(_NS. U.S.EPA ID Number <br /> � <br /> L.L.C. <br /> 1125 HENSLEY STREET <br /> Facili 's Phone: 510 a3J-�jOfl1_ RICHMOND, CA 94301 C A T 0 9 0 0 1 40 7 9 <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 Wt.Nol. <br /> 1' NON-RCELA HAZARDOUS IWASTE STOLID, (C-STANURIC ACID) 331 <br /> 0 <br /> 3 U F 12a P <br /> z 2- <br /> w <br /> C7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information E'RSexviceontractedbyVEST:e + 1,1'VT;3100355 RAID3011355 <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 the terms of the attached EPA Acknowledgment of Consent. <br /> 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. <br /> GeneratoeslOfferor's Printed/Typed Name Signature y Month Day Year <br /> - .r <br /> CHARLES LUCERO 0 0 91 1 3 <br /> 16.International Shipments <br /> t- ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> z Transporter signature(for exports only): Datelleaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printedrfyped Name Signature Month Day Year <br /> 0 °t�INCEPIT 'OME M 0 II I <br /> Transporter 2 Printedrryped Name Signature �' Month Day Year <br /> CC <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> LU 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> ti19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 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 18a <br /> Printed(Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />