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r-N-� U4aj <br /> Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050.0039 <br /> UNIFORM HAZARDOUS 1. Generator ID Number 2. Pagel of 3. Emergency Response Phone 4. Manifest Tracking Number //�� <br /> WASTE MANIFEST CAD014063580 1 800-633-8253 OO �/yT <br /> 5. Generators Name and Mailing Address A] TN: Gary Krebbs Generalois Site Address in amerem man mailing address) <br /> Tracy Unified School District TracyHIgh School <br /> 1875 W Lowell Ave 315 East 11th St <br /> Tracy, CA Tracy, CA 95376 <br /> Generators Phone; 203-321 -3429 <br /> 6:Tran=-poner l Company Name - U.S. EPA ID Numbar <br /> Ingerllum (Sacramento)("ERI PHONE-Gust ID# 8766-0004"") CAR000179747 <br /> 7. 1ranspoder2 Company Name U.S. EPA ID Number <br /> Dillard Environmental Services CA0982523433 <br /> 8, Designated Facility Nameand he Address U.S. EPA ID Number <br /> Covanta Env ronmental Solutions LLC <br /> 5625 Old Porter Rd INR000127621 <br /> Portage , IN 46368 <br /> Faddlys Phone: 219-713-6184 <br /> ga, 9b. U.S. DOT Descrption (urcluding Proper Shipping Name, Heard Class, ID Number, 10. Container 11. Total 12. Unit <br /> HFA and Paling Coup (ifany)) No. Type Ouanlity WLNoL 13. Waste Code; <br /> c `Non-RCRAHa2srdous Waste Liquid (ANTIFREEZE) 343 -1 - -- I <br /> o I J <br /> w 2 Non-RCRA Hazardous Waste Liquid (Oil Filters , Oil) 223 <br /> 1)(V) C ?G --I- - I- -- <br /> 3 Non-RCRA Hazardous Waste Solid (OIL, ABSORBENTS) 352 <br /> 4. <br /> 14. Special Handling Instructions and Additional Inf;magon <br /> Document D 7253 Sales Order 65519 <br /> 1)Proflle#1000140349 DOTER( ( `SS cjj � 3)Prof-ile#1000140351 DOTERG# f'SS rl <br /> 2)PPOE1091000140350 DOTERG# <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION; I her declare that Bre conlEnls of this consignment are fully and accurately descMEd above by " proper shipping name, and ata classified, packaged, <br /> arisd and lah lemplacanded, and are in all respects in proper mndiilon for transport according to applicable interactions] and national governmental regulations. If export shipment and l am The Primary <br /> E porter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknoMEdgment of Consent <br /> i ceNry that ev:asle ninimizalion zlalemen ended in 40C 262.27(a) (if lamalarge quanlity generator) orrygenertorjHtrue. <br /> Generators/Ogen is n e -tl Na Signatme—a 16. Intemalionl Slupmenis �� <br /> Import to U.S. ❑ Bpp n from U.S.Transporter signature (for exports only): <br /> w 17. TranspunerAeMmaledgment of Receipt of Malerials <br /> oTmnsportert Printed!ryped Name Signature .,v Month `Day Year <br /> Transporter der 2 PrintedR dName <br /> W 1Pe agnalure Month Day year <br /> F- <br /> 18. Oisaepancy <br /> 102. Discrepancy Indics5on Space - ❑ Dowdily ❑ T e <br /> yp El Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> 18b.Allemate Facility (or Generator) U.S. EPA ID Number <br /> J <br /> U <br /> LL Facilitys Phone: <br /> w 10e. Signature of Alternate Poetry (or Generator) Month Day Year <br /> 6 <br /> Z <br /> w19. Hazardous Vyaste Repon Management Method Codes lid., codes for hazardous waste treatment, disposal, and recycling systems) <br /> p 1. 2. 3. 4. <br /> ( 20. Designated Facility ONmeror Operator: Certification of receipt of hazardous materials covered by the manifest except as ndedin Item l8a <br /> Printed7ryped Name SionatureLl 1� 0 1 1 Month Day Year <br /> EPA Form 8700-22 (Rev. 3.05) Previous editions are obsolete. . DESIGNATED FACILITY TO DESTINAT6ON STATE (IF REQUIRED ) <br />