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`s, 11-1 <br />Srore of C.Iilornia—En—cumswlal ProteGian Agency <br />Form App.w id OMR No. 2050-0039(E.pim. 9-30-991 <br />Pleee pant or type. farm deigned fes. we on elite! Il pimhJ rypewrikr <br />rW ` <br />002 <br />C:)'. <br />Cr) <br />nJL <br />Cr)2 <br />M <br />3 <br />C <br />Q <br />d <br />r <br />m <br />See Instructions on back of page 6. Dis ximams d Tada S.b.mmae, Can"[ <br />Is <br />UNIFORM HAZARDOUS <br />I. General.,, US EPA ID N. Maaifesr Docum.et No <br />2. Page 1 <br />Informo6ao in the shaded punas <br />WASTE MANIFEST <br />�CAT�00000203119 <br />is not required 6, Faderal low. <br />fjj .41 <br />14 _I <br />of <br />3. Generators Nome and Mallin, Addreu <br />A STbie lAer)1jurQhrment Number <br />Piekel ' s Auto Air 4s RadlatOT <br />t �„ G.eeaWde D <br />- <br />464, Button Jve, Xanteca,CA, 95336 <br />4. Generator's cam <br />5. Tor,f,mrter 1 Campony Name 6. US EPA ID Number <br />G Aw Lritags'arNh 9Y :) <br />Rtaic Environmental C AlD 0 0 9 4 5 2 6 5 7 <br />p: T' PYSs .. <br />7. GmsPoar 2 Company Nome R. US EPA ID Number•%gMpljrle/a <br />F6tjprtipplNli'Nwee <br />9. Designated Faciliy Name and Site Address 10. US EPA ID Number <br />fln,• •, 1.00 <br />Rawic Ewiro■ sal Technologies Corp <br />�.:.., <br />2081 Bay Rood <br />. .. . <br />Fest Palo Alto. CA 94303 1 C1 Al DI 010191415121 <br />- <br />t L US DOi 0.sni tion lindudin Pr Nome, Xa:ord Clou, and ID Num6ar) <br />P 8 aper ShiPPirg <br />12. Ci mminas <br />13. Taxol <br />14 Unit <br />- �- <br />No. <br />T <br />Wonky <br />W,,,ad <br />t Waete Nudber <br />F <br />a <br />t■ne. lipoid. N.O.S., 9 <br />hPG11Z. 22ited tuWw <br />55�pu�, <br />Jia <br />NA 3082 <br />IT <br />,. <br />G <br />F <br />(container Ethylene 61ytx1) <br />O loll <br />frEPAyaft.r. <br />N <br />b <br />seer <br />E <br />.@A/ONier <br />R <br />A <br />T <br />c' <br />syrq.. <br />O <br />EPA/04 <br />R <br />d <br />slate <br />EPA/pthei <br />1. Addliarrd 0eW@6aaibr WoNysbl.lsgil)AISq(9. - <br />'Kt 111 -he Wastes sed Abse <br />15. Special Xondhng masrvamro and AddiLan.' Imiorm.uon <br />GLOVES AND PRO'TECIIVE C.OIHING EMERGENCY RESPONSE PfiCNE 650/325-2666 <br />ROMIC PPDPILE 9201111 13> .Y RESPONSE GurDE BOOL 9171 <br />16. GENERATOR'S CERTIFFGTION: Ih... bydedare shot the contents elthis coni m are fully and accurately described ubovebyproper shipping name ondareciasufted, pecked, <br />labeled, In for by highway <br />marked, and end are all repwn, In proper condition transport according w appllcoble international and Panora government rnulauw,. <br />If I am lot,.q mfr genararor. 1 fy that I hwe a Prooppnm in place to reduce the vdunw and today of waste generated ro she degree I hone determined o be ecommicollyy <br />ble defied -zen <br />pr r:c and that I= tM Wmticable method of tremment, storage di poral currently amiloble Ip aro which m rel the presort and future threat ro human heohh <br />and she anvironmem; OR, if I ore a small quantity gi nar.s. , I how made o good faith often to minimize my wosm generator and select the best waste mooeg.mer, method that b <br />a a <br />pih61. to no. and 11h.,n .t I a Floud. <br />Prim:Name <br />yp.d <br />ms4 , , � x <br />Sig <br />L44 <br />py res <br />d 6 4/J <br />I <br />1l. Transporter I "mol enr of Race) rel M. rials <br />APrin <br />Typed , <br />Sigimtun <br />Month . ^ <br />N <br />S <br />VA41 <br />�� <br />rrlcr <br />1 71 ehF <br />0 <br />18. iron 2 Acknc—lindsomer. d Re<ei teF Maroridr <br />jPrinted/Typed <br />Name <br />5ign.wre <br />Monsh Day Year <br />F <br />A <br />19, Discrepancy Indication Space <br />F <br />A <br />G <br />1 <br />L <br />I <br />W Facility Paner or Operator Cerulicmiandrecei tolhmardro <br />ou, nterlabeve <br />Fhi.ibaecce tas rated In Item 19. <br />credb man <br />7 <br />Penrod /Typed Nome <br />SignaN.e <br />Month Day Yee <br />Y <br />-- <br />l se <br />1 <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) <br />EPA 8100-22 <br />r I '.*ST WITH N '-C'- JAYS <br />•,I A 94312 <br />