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<br /> ' Please print or type.
<br /> Form Approved.OMB No.2050-0039
<br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest TracklNumber
<br /> WASTE MANIFEST CAD9$1456023 2 $00-633-8253. 000247427 DAT
<br /> I 5.Ge "s
<br /> Narpe ap�ling f�.ddeesS, Ge a aloes Sited diff nt tb mailing address)
<br /> Uili�lSlTyUf I he F'a01TIC - rUniversr y`�1e ace Ic
<br /> II 360.1 Pacific Ave 3601 Pacific Ave
<br /> Stockton,CA95211 Stockton,CA95211
<br /> Generatoes Phone: 209-946-2908
<br /> c
<br /> 6.Transporter 1 Company Name U,S.EPA ID Number
<br /> i
<br /> Ingenium ,Sacramento)(****ERI PHONE-Cust ID#8766-0004****) EPA
<br /> 747
<br /> 7.
<br /> I. Transporter 2 Compa U.Sngenium pasX****ERI PHONE-Gust ID#$766-0002****) .E
<br /> 79747
<br /> i I
<br /> B.Deated Fflg Name and Site Add s
<br /> been ors AlFigont`ie,LLC. U.S,EPA ID Number
<br /> 11600 North Aptus Road UTD981552177
<br /> Grantsville,UT84029
<br /> Facility's Phone: 435-8$4-8100
<br /> 9a, 9b.U,S.DOT Descripfion(Including,Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit
<br /> HM and Packing Group(if any)) 13.Waste Codes.
<br /> No. Type. Quantity Wt.Nol.
<br /> 1.UN 5,Waste Flammable solids,organic,n.o.s. methanol gel ,
<br /> o X 4.1 , II DOT ERG#133 331 D001
<br /> LU 2,UN 7 ,Waste orrosive liquids,X n.o.s. Hydrochloric acid), , II 792 D002 D005
<br /> DOT ERG#'154 "7-0 6/ D011 F003
<br /> 3.UN1873,Waste Perchloric acid [with more than 50 percent but not 551 D001 D002
<br /> X more than 72 percent acid,by mass],5.1 (8),1,RQ DOT ERG#143 ` G �� P.
<br /> 4.UNZ031,VVaste Nitric acid [other than reuming;w a least o55 LJUU I Dan
<br /> ppercent,
<br /> than 70 percent nitric acid],8(5.1), 11,RQ DOT
<br /> i
<br /> ERG#157 6 !/
<br /> 14.Special Handling Inshuctions and Additional Information
<br /> rSQ 169209--
<br /> 1)0,1-11d410075 2).131-1101 149 3)C066984-SP LRCTO/UPS-1/05G H2 4)CC66984-SP LCC
<br /> RAIUPS-2105 H2
<br /> 5�c, trMc�
<br /> Contract retained by gen ratorconfers agencyauthoriiyon initial transporter to add or substitute additional transporters on generators behalf.
<br /> 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,
<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)(ifI am a small quantity generator)is true.
<br /> Generators/Offerors PdntecirrypfNme
<br /> 'e. ei Month Day Year
<br /> A a mt),6l
<br /> 16.International Shipments
<br /> F- ❑Import to U.S. ❑Export from U.S. Port of entry/exit-
<br /> Transporter signature(for exports only): Date leaving U.S.;
<br /> IX 17,Transporter Acknowledgment of Receipt of Materials
<br /> LU
<br /> Transporter 1 Pnntedfryped Name�� Signature
<br /> `� (^ Month Day Year
<br /> YPA
<br /> a Transporter2.Pnnted/
<br /> Typed Name Signature
<br /> aC Mdfith Day Year
<br /> 18.Discrepancy.
<br /> 18a.Discrepancy Indication SpaceQuantity ❑Type' 0 Residue ❑Partial Rejection ❑Full Rejection
<br /> 18b.Altemate'Facility(or Generator) Manifest Reference Number.
<br /> -J U.S.EPA ID Number
<br /> V
<br /> Facilitys Phone:
<br /> W 18C.Signature ofAltemate Facility(or Generator)
<br /> z Month Day Year
<br /> y19.Hazardous Waste Report Management Method Codes(i.e. codes for hazardous waste treatment,disposal,and recycling systems)
<br /> 2.
<br /> 3.J 4.
<br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a
<br /> Printedfryped Name
<br /> i Signature Month Day Year
<br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete.
<br /> DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM'
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