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State of California—EnvironMentel Protection Agenc. <br /> Form Approved OMB No.105D*0039(Expires 9-30 See Instructions on �of Page 6. Department of Toxic Sabstonce: <br /> Prose prim or type. form deslpned for use em rifle I r[-pitch)"writer. Sacramento,California <br /> UNIFORM HAZARDOUS 1' Generator's US EPA ID No: M milest Document No. 2. Page 1 Information in the shaded encs <br /> WASTE MANIFEST [' ��.7 j G� [/ [/ en required by Federal kw. <br /> �J 1 of <br /> 3. Generator's Name and Moiling Address A 51r tc Mant,,a Document Nmn6er 2175394 <br /> �qq <br /> Geveke Lodi Dodae G 17 5 3 9 4 <br /> 1255 So. Beckman Road — <br /> r� C6 State Gen velar's ID <br /> A 95240 <br /> 4. yrs P'('209 If- 365-5528 n H1 CN 316101 Qj�g151J- <br /> N 5. Transporter 1 Compete,Name 6. US EPA ID Number C. State Uonsp rt=i s ID)Rescrvrd] - <br /> m ROMIC Environmental Technologies _ <br /> $ CAD 0 0 8 4 fS 2 8 5 7 D r a pa,i Ph.,a 6501324-1630 — <br /> 7. Tramporler 2 Company Name 8. US EPA ID Number E S t 1 ran , I ID <br /> Q Ft_,r r <br /> lJ <br /> B. Designated Focftiy Name and Site Address- — 10,-US.EA4,4Dilem6em jtc�ocl tyslh _: <br /> -,e ROMIC Environment Technologies Q f, i G J 9 4 LS 6 ;,j 7 <br /> K 2091 flay Road <br /> 1�-0 East Palo Alto, CA 94308 CAD 0 0 8 4 5 2 6 6 7 fa5i}i3124-IfSS6 <br /> tt�Q 12. Containers, 13Total 14 Unit <br /> VV 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) . +` <br /> N No: I T Quantity Wt/vol `dri Number <br /> Z a. 6n � <br /> C Other regulated substances, liquid WO.S.9 <br /> 3 G NA 3082, PGIH, RQ, Contains Ethylene Glycol EPA/Otte <br /> 6i N 6' 0 0 '7 T k _ilouls+ <br /> are <br /> W E <br /> a R .lea%od,er - <br /> v A <br /> o T <br /> Slate <br /> m O <br /> _ R EPA/Other <br /> sort.. <br /> U <br /> EPA/Other , <br /> W <br /> --- as rid Yonol Dement nz in Mmcr Lsted Abo.e - <br /> p a"iS:B`.&'.. £tli�+iene Clyco4 <br /> a <br /> (Antifreeze) —.— <br /> tb <br /> 0 15. Speuol Handling I anudian,and Additional Information <br /> Q Moves and Protective Clothing EnieIrgenoy Response Plib" 8001766.4208 <br /> Z ROMIC PFOMO #2041'11 Ehfier <br /> w gaacy Response tiulgeVwk *'171, <br /> r 16. GENERATOR'S CERTIFICATION: Iha..by declare that the contents of this:oansignment are fully aedaccur described above by-propship i"runmeandoracloadfied,pocked, <br /> marked,and labeled,and are in all nspeds in proper condition for transport by highway according to cable interactional aer nd notionaPgovemment regulations. <br /> -+ If I am a large quantity gerrerotor,I orfify that I have a pro <br /> pram in place to reduce the volume and toxicity of waste generated m the degree I have determined so 6e economlcall <br /> 2—L praclim61.and that I have selected the practicable me"of tream ent,storage,or disposal cummly available to me which minimizes the present and Ivmre threat to human heall <br /> and Bse environment,OR,if I am a small quantity generator,I have made a good bilk effort to minimize my waste generation and select the best waste management method that <br /> O available te,me and Bat I can afford. <br /> >. 'nted/Typed Nama'- Si naNro - _ Month Day Y <br /> T 17. Trans 1 Acknowledgement of Receipt of Materials <br /> R . <br /> A PriMed/Typed Name Sion ro _ — _-_ Month Day /Y^, <br /> aL i 18. 'From 2 A.Innowledgesseent of Receipt of Materials <br /> 0 R Primod/Typed Name - S' aNrs r/ MOMh Day Y <br /> T <br /> y F <br /> VF 19. Discrepancy Indication Space <br /> Z A <br /> C <br /> L <br /> ( 20. flu Owner or Certification of metal of hazardous materials covered_ this en s,anuosestors entad in Item 19. <br /> T Prin <br /> Y <br /> / <br /> ( � DO BELO ._:__. <br /> II Yellow: TSDF SE S T S COPY TO GENERATOR WITHIN 30 DAYS. <br /> DISC 8022A(1/99) \_ (Generalors�wh submit hozordoas waste for transport out-of-slate, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days <br />