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Please print or type. V i T Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 12.Page 1 of 1 3.Emergency Response Phone 14.Manifest Trarrekkin Number r� WASTE MANIFEST CAD981456023 2 800-633-8253 .00 O G:4 7A 2 6 DAT 5.Generators,Name and Mailing Address ATTN:Mike Ublck Generator's Site Address(if different than mailing address) University0fThe Pacific University Of The Pacific '3601 Pacific Ave 3601 Pacific Ave Stockton,CA 95211 Stockton,CA 95211 Generator's Phone: 209-946-2908 6.Transporter 1 Company Name U.S.EPA ID Number Ingenium (Sacramento)(****ERI PHONE-Cost ID#8766-0004****) CAR000179747 7.Transporter 2 Company Name U.S.EPA ID Number Ingenium (Milpitasx****ERI PHONE-Gust ID#8766-0002****) CAR000179747 8.Designated Facility Name and Site Address U.S.EPA ID Number Covanta Environmental Solutions LLC 5625 Old Porter Rd INR000127621 Portage,IN 46368 Facility's Phone: 260-240-2461 ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit and Packing Group(If any)) 13.'Waste Codes HM No. Type Quantity Wt./Vol. o 1'Non-RCRA Hazardous Waste Liquid(MOBIL VACTRAOIL NO.2 221: ,, . AND WATER) Y� 6�. 2'Non-RCRA Hazardous Waste Solid(rags,waste oil) P 352' 3'Non-RCRA Hazafdous Waste.Liquid(latex paint) 291 060 P 4. 14.Special Handling Instructions and Additional Information D90970$O 169203 1)11000338 8 2)41465 61 ` 3)41466318 (� 0e,Gorsr ct retained�Zi Sf by generator confers agencyauthorityon Initial transperterto add or substitute additional transporters on generatore'behalf. 15. GENERATOR'S/OFFERQR'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 Intemational 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 EPAAcknowledgment of Consent. certify that the waste minimization statement identified In 40 CFR 262.27(a)(if I am a large quantity generator)or.(b)(If[am a small qubntity generator)is true. Generalor's/Offeror's PrintedfTyped NameSI Month Day. Year n Ira ,k l 9 16.InteAtIonal Shipments ❑import to U.S. ❑Export from U.S. Port of entrylexil: ? Transporter signature(for exports.only): Date le ng U.S. W_ 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Pdntedfryped Name Signature Month Day Year f4 I Iq U) Transpofter 2 Printed/Iyped Name Signature Month Day Year a' r H 18.Discrepancy 18a.Discrepancy.Indication Space ❑ Quantity ❑Type I_ I Residue ❑Partial Rejection ❑Full Rejection Manifest Reference'Number: 18b.;Altemate Facility(or Generator U.S.fPA ID.Number Facllitys Phone: LU 1Be.Signature ofAkemate Facility(or Generator) Month. Day Year z .. 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted In Item 1 Be Pdntedfryped Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM