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Please print or type. - 1 V l� Form Approved.OMB No.2050.0039 UNIFORM HAZARDOUS 1•Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,Manifest TrackinNumber c WASTE MANIFEST CAD981456023 2 800-633-82531,0002: T.4 2 V DAT .5.Generators.Name and Mailing Address .ATTN:Mike Oblck Generator's Site Address(if different than malling address) ( U n ivers ity Of Th e Pacific University Of The Pacific 3601 Pacific Ave 3661 Pacific Ave Stockton,CA 95211 Stockton,CA 95211 Generators Phone: 209-946-2908 6..Transporter 1 Company Name U.S.EPA ID Number Ingenium (Sacramento)(""ERI PHONE-Gust ID#8766-0004" "'") CAR000179747 7.Transporter 2 Company Name U,S.EPA ID Number Ingenium (Milpitas}(****ERI PHONE-Cust ID#8766-0002*"") CAR000179747 8,Designated Facility Name and Site Address U.S.EPA ID Number Covanta Environmental Solutions LLC INR000127621 5625 Old Porter Rd INR. 000127621 IN 46368 Facility's Phone: 260-240-2461 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13:Waste Codes No. Type Quantity Wt./Vol. o: 1'Non-RCRA Hazardous Waste Liquid(MOB.IL VACTRA OIL NO.2, . AND WATER) 1��✓ /� 221 2Non-RCRA Hazardous Waste Solid(rags,waste oil) 352' - 3'Non-RCRA Hazardous Waste Liquid(latex paint) 291 06a 4 14.Special Handling Instructions and Additional Informati9n D90970 SO 169203 1)11000338 8 2)41465 61 3)41466318- .- 3 0� (`�fVS5' vo.ts:r �1 ontract retained by generator confers agency authority on Initial tons porter to add or substitute additional transporters on generators'behalf. 15. GENERATOR'S/OFFERpR'S CERTIFICATION: I hereby declare that the contents of this consignment are.fully end 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 Intemationaland national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terns of the attached EPAAcknowledgment of Consent. Ice"that the waste minimization statement identified in 40 CFR 262,27(a)(if I am a large quantilygenerator)or,(b)(Ill am a small quantity generator)is true. Generators/Offerors Printedfl'yped Name SI Month Day. Year t l ` -�3 16.International Shipments I- ❑import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports.only); Date le •ng U.S. W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printedfryped Name Signature r' Month Day Year �o J l 10 Iq Transporter 2 Printedffyped Name Signature Month Day Year r F 18.Discrepancy 186.Discrepancy Indication Space . ❑ Quanti {�1 ❑Partial Re ty Type LJ Residue Rejection j ❑Full Rejection Manifest ReferenceNumber: 18b;Aitemate Facllity(or Generator) U.S.EPA ID Number V Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month. Day Year a z .. i 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. 2 3. 4. Ll20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedfTyped Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM