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Please print or type. ""` # I Form Approved.OMB No.2050.0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST1. CAD981456023 2 800-633-8253 000247425 DAT 5.Generator's Name and Mailing Address ATTN:Mike Ubick . Generator's Site Address(if different than mailing address) University Of The Pacific University Of The Pacific 3601 Pacific Ave 3601 Pacific Ave Stockton,CA95211 Stockton,CA 95211 Generator's Phone: 209-946-2908 6.Transporter 1 Company Name U.S.EPA ID Number In enium (Sacramento)(""ERI PHONE-Cult ID#8766-0004**** CAR000179747 7.Transporter 2 Company Name U.S.EPA ID Number Ingenium (Milpitasx****ERI PHONE-Cust ID#8766-0002****) 1. CAR000179747 B.Designated Facility Name and Site Address U.S.EPA ID Number Recicladora TOmarryde Mexico,SA de CV MXC130610001 Carr.Fed.No.2,Mex Tij,KM 121 San Pablo Tecate,BC,Mexico, CP21530 Facility's Phone: 619-270-9453 Chemtrec 2417#EMERGENCY(800)424-9300 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Contalners 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Noi, 1'UN1993,Waste Flammable liquids,n.o.s-(ethanol,toluene),3,II D001 F003 F005 X DOT ERG#128 ©© a- r��. 4 (©n 331 LU 2'NA3077, Hazardous waste,solid, n.o.s.(lead nitrate, methanol),9, D006 D007 D008 X III DOT ERG#171 ' ®O 00 F003 F005 352 3. 4. 14.Special Handling Instructions and Additional Information D90971 SO 169203 - 1)R18-21060 2)R18-21062 `yXG`jg) A „j Primary Exporter:TemarryRecycling,Inc.AOC Solvent 020514 E18001 Aqueous 020526 El 8001 Solid 020530 E1800 15. GENERATO 'SIO FEROR'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;packagod, 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)(ff I am a small quantk generator)is true. GeneratoeslOfferoes PdntedlT Name Si Month Day Year - 111LON1�0,S1 _aM 00jaku ltb Ito 14 16.Int mational Shipments P- ❑Import to U.S. Export from U.S. Port of entry/exit: 2596 91 Transporter signature(for exports only): . Date leaving U.S.: W 17.TransporterAcknowledgmenl of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year a U) Transporter 2 Printed/Typed Name Signature Month Day Year a! Y 18.Discrepancy 18a;Discrepancy Indication Space ❑ Quantity ❑Type ❑Residuej ❑ j ❑ParBal Rejection Full Rejection Manifest Reference Number: 16b.Alternate Facility(or Generator) U.S.EPA ID Number J V Facility's Phone: LU - 11 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. 2. 3. 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. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM