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03-2T-2006 10:36 <br />From-CUST SERVICIS <br />.I <br />State of Callkrnla—Envimonto <br />e,al PrmMian Agency. <br />Form Aovmved OMB Ne. 2030-0039IE.pRo 9-00.991 <br />Plea» oriel er ryPe. Fern deigned kr me on dib fJ2-pikhJ ypewdror. <br />+ * T-349 <br />Sae Instructions on back of page 6. <br />P.001/001 F-901 <br />r eparan..' of Taeie Subaham.t COAbd <br />Sacrammro, WIF ..in <br />DO NOT'WRITE BELOW THIS urge. <br />r - wh;,c TSDF SENOs'HIS CCPY TO DTSC WITHIN 30 DAYS.. <br />MCG E022A Il/991 n. P.O. Be. 100. sam<mmnv CA 95812 <br />EPA 8700-22 <br />HAZARDOUS <br />L Gen..te. UB EPA ID No. Menilar 0.cvmeN No. <br />2. Page l <br />Int-armetian m 16 shaded .,UNIFORM <br />is +m mw�md 6, F.d.ral law. <br />WASTE MANIFEST <br />0 0 0 2 5? 4 4 5 <br />I <br />of 1 <br />3. GenemmiaN... and M.M., Add.... <br />PACIFIC COAST N.B. IND., INC. <br />A. Slafi Mvnileu DaaumeM Numi.r 25127114 <br />4101 N. HOLLY DR. <br />B. Store G.n.mbra ID <br />TRACY, CA 95378 <br />A. G.e»m»re Phan- l 209 886-9624 Contact: JOSH DANIEL <br />I I I I I I I <br />S. Tmnapermr l Campaey Name <br />S. US EPA IDNumb.r <br />C. Shale Tranrvutmee 10 [Pon 41 <br />ROKIC RNYEHONNBNTAL TECH, <br />0 9 9 S Z fi 5 1 <br />D.TmmParm/e Pham(P41324-1636 <br />7. Tmeparer 2 Company Nom. <br />S. US EPA ID Number <br />E. Stem TrvmiwMr'r 10 [0.wrn d.l <br />F. TranaporM'e Phone <br />9.DNlvraled faclliy Nom. and Site Add,., a <br />10. US EPA ID Numb.. <br />G. Stam Facilly'r 10 <br />�8 IB Ill 4 5 2 6 5 i <br />HONIC ENVIRCNNENTAL TRCB <br />2081 BAY ROAD <br />C A D B B 9 4 5 2 6 5 7 <br />H. F.1ity, Ph. I6! BI324-1638 <br />BAST PALO ALTO CA 94303 <br />---1 <br />IvUS DOT DaucA;P,ian ImOuding Propn Shipping Nome, Ha.ad C are, and l0 Num6erl <br />13. Gnmimrs <br />13. Total <br />Ouvmiry <br />le, Unit <br />'NI/Vd <br />1. Waah Number . <br />Na. <br />T <br />a)ABSORBRNT ROOKS/PADS;PPROLR1IR OIL) <br />Stone <br />352 <br />EPA/gher <br />O <br />- <br />Frill R 341034 ERGs <br />) <br />RONE <br />BbIP8TROLROK <br />OIL) HRLANUUUb 11 1,1911411- <br />2 + <br />EA/aM1e <br />- BONI <br />R <br />Prfl► E 341833 ERGS <br />0 <br />A <br />T <br />aIPOLYBTBYLRNB GLYCOL,2ATiR1 <br />Sora <br />134 <br />EPA/Otber. <br />O <br />R <br />PrEli R 358219 BRGSAQID <br />10 <br />d, <br />stat <br />EPA/O&, <br />1 Aeldit' a ,p,ione far Material, tinted A6aw <br />- <br />R. Hm+dlinR Code hr Woame.tlNd(A/6y'/veI <br />I. <br />1 <br />IS. SPebal Handling lmhu'"no and Addharead rmWien <br />i'. 4 _ -9 4 !36 <br />la. GENERATaR'S CERTIFICATION: Ihereby dedam lhmtheeommrh of YJe eomignmen, are fully and oaumml deatbedabamb) propvnbivpmg mm�e and Era dmelli.d,pwM1ad, <br />kr Nghwy m appllcobk inmmmioml nml mlio al go—mment mgalmiom. <br />marked, end la6d.d, a�td or. in all r..p.m in proper cadition benepon W «mdi,g <br />IF I em a brg quo n pen tat ceniy Ihar I hove a <br />prog in plan m rodum the vdume vd Toxidy 1 wee genmgrod to the d.dme I h, .. d.tv—ti d I. be econamimllr <br />h mge, ar dtp 1 cmr•ntly evailabl. to me whl.h mi�dmice 16 preont end thmvr m hu n heoMh <br />aroaimbly and that 1 haw ad.crod the nail.61. method al .nra—1,'e artature <br />ad the •mimren.1; OR, it I om a moll gwmlty g.nommr. I have mad. o good Faith ,flee m min raly my wev. Iwn.rwian »d »IM tbe bel wet. ma.egemant ..,hadthat it <br />evalla6le a are and that I cae afford. <br />- <br />Prima!/T N me <br />SiBnawe — <br />Month Dq ywr <br />v <br />'Q <br />d <br />j . 1 <br />17. True"n., 1 Adn velec e m el Roc. i of MeroHda <br />Month DaY Year <br />j <br />R <br />Prinmd/Typd Nuns <br />o <br />D <br />P <br />B <br />lE. T.aiypd ne 2Aamenld Rvwi t.f Mvteriola <br />Manrh Day Year <br />Nral. NameeLmwkd <br />6lgnamry <br />j R <br />..19. Dixrepancy lndkalbn Space L.I Tr-E.II 1 <br />pct �J".4I(I� ilr u1C.1 I1 1�CfIJ i+lS 1"hdI�i�'i0.� <br />�CQ111%x <br />F <br />;? ciPd on <br />rn,, 6, ; f 3�// <br />_ =x-TdTF4LxsT .. <br />big x' weir Aug-€- rzzr�cb 31 <br />IA <br />L <br />20. Fedlt Owner ar rotor Grbficdion d tort I el hvzmdwa mateiaB <br />,m9-airl'Ir <br />ibn n , as ret <br />Da/ oar, <br />Sn/4rinid/TypdNam �� ' <br />CMoN� / a <br />— <br />DO NOT'WRITE BELOW THIS urge. <br />r - wh;,c TSDF SENOs'HIS CCPY TO DTSC WITHIN 30 DAYS.. <br />MCG E022A Il/991 n. P.O. Be. 100. sam<mmnv CA 95812 <br />EPA 8700-22 <br />