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Please print or type. ""^" O Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2,Page 1 of 3,Emergency Response Phone 14.ManlfestTrackin� Number <br /> WASTE MANIFEST CA0981456023 2 800-633-8253 ,ooO G 7 A26 DAT <br /> .5.Generators_Name and Mailing Address .ATTN;Mike Ubick Generator's SlteAddress(if different than m'alling address) <br /> University Of The Pacific University Of The Pacific <br /> 3601 Pacific Ave 3601 Pacific Ave <br /> Stockton,CA 95211 Stockton,CA 95211 <br /> Generators Phone: 209-946-2908 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Ingenium (Sacramento)(***`ERI PHONE-Cust ID#8766-0004"",') CAR000179747 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> Ingenium (Milpitasx****ERI PHONE-Gust ID#8766-0002****) CAR000179747 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Covanta.Environmental Solutions LLC INR000127621 <br /> 5625 Old Porter Rd INR. <br /> 000127621 <br /> 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)) <br /> No, Type Quantity Wt./Vol. <br /> 1'Non-RCRA Hazardous Waste Liquid(MOBIL VACTRAOIL NO. <br /> . AND WATER) 1�r✓ Q" /" 221 <br /> 2'Non-RCRA Hazardous Waste Solid(rags,waste oil) 352' <br /> 3•Non-RCRA Hazardous Waste Liquid(latex paint) 291 <br /> 06o <br /> 4 <br /> 14.Special Handling Instructions and Additional Information D90970 SO 169203 <br /> 1)11000338 8 2)41465 61 ` 3)41466318 <br /> Ms 0e, <br /> ontract retained by generator confers agency authority on initial iransperterto add or substitute additional transporters on generators!behalf. <br /> 15. GENERATOR'S/OFFEROR'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 EPAAcknowledgment 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[am a small quantity generator)is true. <br /> Generators/Offeroes PrintedlType Name Si Month Day Year <br /> A\K' -\ole.Ak Caa4ko Iloilo <br /> 9 <br /> 16.International Shipments <br /> F_ El import to U.S. ❑Export from U.S. Port of entrylexit <br /> ? Transporter signature(for exports.only): Date le 'ng U.S. <br /> IX 17.Transporter Acknowledgment of Receipt of Materials <br /> F- Transporter 1 Pdnted/TYPed Name Signature <br /> 0Month Day Year <br /> U) Transporter 2 PdntedfTyped Name Signature Month Day Year <br /> oC r <br /> F <br /> 18,Discrepancy <br /> 186.Discrepancy.lndication Space ❑ quantity ❑Type I__I Residue ❑Partial ReJectlon ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b;Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> LL Facllilys Phone: <br /> LOU 18c.Signature of Alternate Facility(or Generator) Month. Day Year <br /> CDQ <br /> Z .• <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> i 1, <br /> T. 3. 4. <br /> Ll20.Designated Faclllty Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a <br /> Pdnted/ryped Name SignatureMonth Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO ' <br /> EPA s e-MANIFEST SYSTEM <br />