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I Please print or type. 17 m Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page1 of 3.Emergency Response Phone 4.Manifest Trackin Number WASTE MANIFEST CAD981456023 2 800-633-8253 ,00 O Z. 7 4 Z 6 DAT 5.Generator's Name and Mailing Address ATTN;Mike Ubick Generator's Site Address(if different than mailing address) U n ivers ity Of The Pacific UnivarsityOfThe Pacific 3601 Pacific Ave 3601 Pacific Ave ! Stockton,CA95211 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 i 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.Tota! 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1'Non-RCRA Hazardous Waste Liquid(MOBIL VACTRA OIL NO.2 221 AND WATER) Y �� 2'Non-RCRA Hazardous Waste Solid(rags,waste oil) 352 CD Ick P 3'Non-RCRA Hazardous Waste Liquid(latex paint) 291 4. 14.Special Handling Instructions and Additional Information D90970 SO 169203 fj 1)11000338313 2)41�4 65P�61/ 3)41466318 1 410(1 Contractretained bygenerrator confers agencyauthorityon initial transporterto add or substitute additional transporters on generators'behatf. 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, marked and!abetedlplacarded,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 allached 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)(if I am a small quantity generator)is true. i GeneratorslOfferors Printed/Typed Name Month Day Year Si, ! �} 416 in M-S. 16.International Shipments F ❑Import to U.S. ❑Export from U.S. Pori of entry/exit: ? Transporter signature(for exports.only); Dale Ie 'ng U.S. ' W 17.Transporter Acknowiedgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year a 1ca Transporter 2 PrintedlTyped Name Signature Month Day Year Y F 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Residue I ❑Full Rejection ❑Type El Rejection Manifest Reference Number: 180.Alternate Facility(or Generator) U.S.EPA ID Number J_ V LL Facl!itys Phone: w 18c.Signature of Alternate Facility(or Generator) Month. Day Year a z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) J 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as nded in Item 1 Be 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