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Please print or type.(Form designed for use on aide (12-pitch) typewriter,)_, _ Form Approved. OMBND. 2050-0039 i <br /> UNIFORM HAZARDOUS1. Generator ID Number - - - 2. Pagelof 3. EmergencyResponsePhone - 4. Manlfeot TrockiNumber <br /> WASTEMANIFEST CAD014083580 1 800-833-®263 .10001 ,69674 ®AT <br /> S. Gaheistpda Nemeapd MaillnAAddreseAt MUSFYKIIEDIDS Generator's Site Address ( Polgarentthan malling address) <br /> TimUni6sd S& I Dishict TracirHigh School <br /> 107'1N LbWOII Ai6 315 East I ltb St <br /> Tracy, CA Tracy, CA95376 <br /> Genoraror's Phone:. _ 208-3214429 - <br /> 6. TranspoMrlCompanyName - U.S. EPA ID Number <br /> Ingenium (Sacsemento)(e4"ERi. PHOdECustiD# 8788-0004A0") CAR000179747 <br /> 7:Tmwpoder2 Cmr� :ryaName �- - /' - - " - - 0.S. E=Niumar <br /> Ll <br /> 6.➢es d acglly Nams'ani SiteAddress " U.S. EPA ID Number _ <br /> WSEcD)oogqyy.. Be . <br /> Highway 96 - 12�, S flPBeatty NVT330010000 <br /> BeaBy, NV 89003 <br /> Fahllil sPliom BM239-3943 <br /> go9b. U.S, DOT Description gncludiig Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Toal 12 Unit 13. Waste Codas <br /> HM and Packing Group (it any)) No. Type Quantity III <br /> 1•Non-RCRAIII IDus VVasta Solid (floor dry, broke shavings) 181 <br /> 00 ( bm <br /> z P. <br /> au <br /> 3. <br /> 4. <br /> 14:Speblall{arlinglnsbuGioAssntlAdO.l6onal hdpimaUon <br /> DocLment D52763 galea Order 77982 <br /> 1)Pro le#070128300-28519 DOT ERG# <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents ofihismmsgnmanlarelully and accurately described above by the proper shipping name, and are dassifisd, packaged, <br /> marked and labeledlplacarded, and are in all respects In propermMlUon for transport according to applicable International and refund governmental regulaUone. if overt shipment and I am the Primary <br /> Expoder, I caugly that the contents of this consignment mldo e0 the toms of the attached EPAAdmowledgmenl of Consent <br /> I snugly that the waste minimization statement k enUUed in40 CFR262,27(a) (if Ism a laigequaolify.ganodund) or(ti)Q1l am a small quantity generator) Is (me. I . <br /> GademlbeshOINII Prirdedllyped.Name ' Signe Month Day Year <br /> �/�6 /OL /' <br /> l <br /> 16. Int Uona Shpmenls ❑ import to U.S. ht' <br /> ❑ Export from LLS, Pod of en lexll: . <br /> = <br /> Transporter signstum (for exports only): Dale leaving U.S.: <br /> W 17. TranspoderAcknowtedgmentofRecelpt of Materiels- <br /> Tmnsprder 1 Prinoulffped Name . Signature ( " - - Month - ' pay Year <br /> tL zc 117 <br /> N _ .. _ <br /> Transpoder2P 'Plndllyped Nope -:Slgnoure Month Day Year <br /> ( Z ! <br /> 18. Discittlancy 7—t <br /> 18a. Discrepancy fndloa6on Space ❑ Quantity ❑Type El Residue ❑Perot Rejection El fruit Rejection <br /> Manifest Reference Number. ma <br /> Ise.Alternate Fedlity (or Generator) " -- - U.S. EPA ID Number - <br /> J_ <br /> V <br /> ran- Fecllifys Phone: _ . <br /> W. Its. Signature ofAlfamate Faciityor Generator 'Monty Oay Year <br /> Q <br /> W19. Hazardous Waste Report Management Method Codes(,e.-, codes for hazardous waste treatment, disposal, and recycling systems) <br /> � 1 - _ _ _ - ., . _ 2 . . . _ _ 3, 40 <br /> 1 _ <br /> 20 DestgnaWF?-rJII Owneror0pamiar. CeTlMmtonofine iptothazardouematedalscovaTedbylhemanlfesteXgepl as noted In Item l8e <br /> PdrdetllTypetl _ . .. " . . . _ <br /> SI alum�]_---' � ` " �"" - nth Day Year '. <br /> ams 9n Mo <br /> EPA Form 8700-22 (_ oo.3_q ) revlousedltlorisare ohsolate,�~— - DESIGNATEDFACILITYTODESTINATIONSTATE (IF -REQUIRED) <br />