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ATTACHMENT A <br /> lease pont or type. (Form desngnod for use on elite ( 12• pdch) typewriter. ! , 1 Form Approved. OMB No. 205GM39 <br /> UNIFORM HAZARDOUS T. Genenalcr IONumber 2. Page 1 of 3 E,fnetponyResponse Phone4. M nit etT n N <br /> WASTE MANIFEST CAD9BW935% 1 1 -888.785.7225 �. ( � 4796 FLE <br /> nefatofs Narne and Mailing 'Address Generators Sile Address (if different than mailing address) <br /> Manteca Unified School District <br /> 2271 W LOUISE AVE <br /> Manteca, CA 953W <br /> Generator's Phone' <br /> 5. transporter arse U.S. EPA ID Number <br /> Advanced Chemical Transport Inc . (SV) CAR000070540 <br /> 7. Transporter 2 Company Name U. S. EPA ID Number <br /> Worldwide Recouy System , !nc CAR000175422 <br /> 8. Ces"Ied Fadl'ty Name and Ste ess U S. EPA to Numixr <br /> Yuma YES, LLC <br /> 2730 E , 13th St AZR000515924 <br /> Yuma, AZ 85365 <br /> Facilit 's Phone. 926w344g828 <br /> ga. 5b. U S. DOT Descriplwrn (Including Proper Stvpp+ng Name, Hazard Class, 10 Number, 10. Conlalners 11 . Total 12. Unit 13. Waste Codes <br /> Hirt and Packing Group (d any)) No. Type Quantity VANd . <br /> o Non- RCRA Hazardous Waste, Solid , (Oily Solids)) r P 352�a I <br /> uj <br /> 2I�IpN - 7.pt � s .uws�-� send j � � 3s�! <br /> I <br /> 3. <br /> J <br /> t <br /> 4 • I <br /> Ia. Special Handling Instructions and Addrtonat Information roject Number 14662,2A ^ Document #: D175888 <br /> 1 ) 176643MAYS01 0 I7017rf� q A1 � D0 �: <br /> i� � L911 ) i C 01 fkLill S 0 � <br /> 15. GENERATOR'SlOFFEROR'S CERTIFICATION: I herety declare that the contents of this consignment are fully and accurately descrdod alae by the proper shipping name, and are classi ted, packaged, <br /> marked and latxied'ptacardod, :M are in all respects in proper wnd4tion for lranspoil aocadkV to applicable international and national Witemmentatregutanons. If export shipment and I am one Primary <br /> Exporter, I certify peel the contents of this consignment conform to the terms of the arached EPAAcknowtedgment of Consent. <br /> I certify that the waste m n:mization statement Identified in 40 CFR 262 21(a ) ( I I am a large quactity generatof) or (b) (d lam a small quantity generator) is true. <br /> nereto 0 a nn' Name b9natureo Ar ea <br /> C <3 !/ e <br /> t . fnlemalional Sh Rots <br /> Z ❑ Import WUS. LIE xporttomUS Port dlentryieur <br /> Trans ter signature (for ex ns on:j). Dateleav fig U, S . <br /> 17. Transporter kJulo +ledgmenl of Repeipt of IAatenals <br /> K Tria 1 P It Alamo <br /> a :g al on' <br /> t ✓1 a-te Z <br /> i Trensporlerrinted7Typed meSignature IF Monthay ear <br /> 18. Discrepancy ` <br /> 183. Discrepancy Indialon Space ❑ Quantity ❑ Type ❑ Resid:ie ❑ Pad ai Rejexcln ❑ Full Rejection <br /> Manifest Reference Number <br /> 18b. Alternate Fad y (or Generales) U. S. EPA ID Number <br /> J_ <br /> V <br /> W Faoli ! 's Phone _ <br /> w 18c. Signature ofA temate Faality (a Generaloo 1 Mmin Day Yea <br /> ti -- <br /> 1g Hata does 1'yaite Re) ort 613ragcmant 1JctRod Coos (i c . co'g . Icr hata+dous + as:e Veath, d sposat and re;yctng sys'.ams) <br /> Q <br /> 20. Designated Facility Ovmeror cigar Certr alion f reolli of hazardous materiall cowed by the manifest except as noted in Item lea <br /> Pnnledffyi td N Signature Mei h Day Yea! <br /> EPA Form 8700.22 (Rev. 3.05) Previous editions are obsolete , DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />