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Stale of California—Environmental Protection Agency ,y <br /> Form Approved OMB No.2050-0039{Expires 9.30-991 See Instructions on backege 6. <br /> Pleaso print or type. FarT designed for use on efife(12-pit ewriter. Department of Toxic Substances Control <br /> Sacramento,California <br /> UNIFORM HAZARDOUS 1' Generator's US EPA 1D No. Manifest Document No, 2. Page I Informalion in ilia shaded areas <br /> WASTE MANIFEST is not required by Federal law. <br /> 3. Generator's Name and Mailin Address <br /> Int�tra���l� Itltallrlaltitlrlaae A. State Manifest Document Number �j+� +� <br /> 8i26Navy Drive 23329444 <br /> sn *t64*t6n, CA 952O�f :B. Stalefaneratlr's:I�D��4. Generator's Phone ((209))0,e-11821 <br /> Lr) 5. Tra sorter 1 Company Name &. US EPA 1D NumberCP IAC) NC EnvirOnMent al Technologies C. Stale Tronsporter's . <br /> 0 <br /> OR n 4 �y, y D. Transporlar's Phone �i�ty�r� y�+�{� <br /> _ 7. Transporter 2 Company Name � V - 65!/�I+II�J 4-11 fl38 <br /> B. US EPA ID Number <br /> E. State Transporter's ID[Reserved,] <br /> F. Transporler's Phone <br /> �~ l0. US EPA ID Number <br /> 9. Desi noted Facility Name and Site Address - <br /> c ,s l lw rrrr rv�trr►eret `I' ahnnlogres 1:,Q f x 's 10 <br /> °t G Stalefacilify <br /> o"I Z 2'081 Bay Road �7 .Q, � .� � 0. 2 .611 �. <br /> � � �8�i� � 1� ie4ltty, � 0 H facility's Phone <br /> C AI D 0 OU 1 4 5 2 6 5 '7 ' 6501324-1638 <br /> CQ U 1 1. U$DOT Description(including proper Shipping Name,Hazard Class,and ID N'um6erl 12. Containers 13. Total 14, Unit <br /> Z n. No. Ty e Cluantily Wt/Vol I. Waste Number <br /> CAher regnla>ted Substances, ii+qu.a i lti_i;.5.:s.0 state 343 <br /> G NA 3082,.Pdlll, Rai, i�`cftlirls Ethylene GIVcol EPR/other. ._ <br /> 6605 E <br /> Seale <br /> v R <br /> C14 A <br /> EPA/Other <br /> 80 p Stole <br /> R <br /> I � EPA/Olher <br /> LU <br /> I- — <br /> Z State <br /> U <br /> w EPA/Ocher <br /> QEn J. A��dyd�itional Descri tions for Materials Listed Above <br /> W 0'Efilylerie Glycol . - K. Han 'ing Codes for Wastes listed Above <br /> CL. x_a .. <br /> d c• d, <br /> Z. <br /> a 15. Special Handling Instructions and Additional informofion <br /> Q <br /> 03aves nnd Protective Clothing <br /> Emergency Response Phone 0001766- 48 <br /> ZIDDM I Profile #20111•i 1 <br /> = Emlv»SgeftcY Response Guido Book NVII <br /> -�-s =Pr- <br /> 'S CERTIFICATION: I hereby declare that the contents of Ibis consignment are fully and accurately described above by proper s6ipping name and are classified,packed, <br /> l4J and!labeled,and ore in all respects in proper condition for tranaporl by highway According to applicable international and national governmaa regulations. <br /> J <br /> ge quanlily generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> V) nd that I kava selected the Practicable method of Ireatmenl,storage,or disposal currently ovaila6l_to me which minimizes the present and future threat to human heahh <br /> rx ronment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> Q available to me and that I can afford. <br /> >- N <br /> U t /typed Nay� <br /> Signature month /1Day Year <br /> �' T 17. Trans ortar!Acknowlad errant of Recei t of Materials t" l / <br /> R <br /> LLJ <br /> A Printed/Ty 'ed Name <br /> H Sf,n lure <br /> S Month Day Yea <br /> LU P r� r <br /> 0 18. Trans orter 2 Acknowled amen!of Recei t o Materials <br /> 0 <br /> Q 8 Printed/Typed Name <br /> tL E Signa re <br /> g <br /> R Month Qay Year <br /> U 19. Discreponcylndication Space <br /> Z F <br /> A <br /> C <br /> I <br /> t <br /> fPrinted/d/Typed Noma FTOwner or Operator Cerlificalion of recei I of hazar <br /> T Prdous malaria ls covered 6 this manifest -ept as noted in Item 19. <br /> y - ' <br /> Y Signature <br /> Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DT5C 0 f1/99J <br /> EPA 87700-22 Blue: GENERATOR SENDS THIS COPY TO DISC WITHIN 30 DAYS. <br /> To: P.O. Box 400, Sacramento, CA 95812.0400 <br />