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9 <br />i <br />t DO NOT WRITE BELOW THIS LINE. <br />I DTSC JIMA (9/93) Yellow: GENERATOR RETAINS <br />F EPA 8700-22 <br />1 <br />L— — — — — — — <br />Sime d CaBforrio--Emiro s "'s j Protectors Agency <br />Fou Alrprared OMS No 2030-OW9 (Egwq 9-3690 See Instructions on Ibo fe 6. <br />PhmT Prn a type. �9 OcmrhnmM of Toni Substarees Control <br />"%W Savanemo, CaYtorm <br />UNIFORM HAZARDOUS 1. Ct e a or's US EPA ID No. Manifest Docamenl Na. 2. Page 1 nFa a on in The shaded areas <br />required by Federal law_ <br />WASTE MANN$T b tar reqder <br />��s�"ci Ce00008880 ♦ 1 I of <br />3. Gemrmoi s Nurse and MmZrg Address <br />THERESA N. ,MARLER N'""53600192 <br />540 N. SANTA CRUZ #123. LOS GATOS, CA. 95030 a. Store cane.ma,.a <br />In <br />s. Gvs.orar'' phone (408) 395-3991 <br />n <br />. 5. Transporter 1 Company Npnne d US EPA ID Number <br />C SMe TqM g, J <br />C� <br />- <br />PKEROLEWWCYCLING CORP. A IT 10 18 10 10 11 11101519,° <br />Tnospo a 892-6742 <br />C <br />7. Transporter 2 Company y Nome 8. US EPA ID Number <br />'.E. Slate T ransporter's ID <br />J <br />C <br />F. Trueportefs Phone <br />9. Desi Facility Norrie and Site Address 10. US EPA ID Number <br />G. Store Facility', ID <br />CAD083 11166728 <br />4TPRW'FATTER$ON <br />331 N. HNC 33 <br />x TmTey''s Pham <br />�I <br />PATTERSON, CA. 95363 CA D 0 8 3 1 6 6 7 2 8 <br />I <br />209 •92-6742 <br />P <br />11. US DOT Description (including Proper Shipping Nome, Hazord Cloy, and ID Number) <br />12. Cmeae <br />13. Total iIA. <br />Umt <br />No. <br />T <br />Ouumiry i <br />W! Vol <br />11 Waste Nsnber <br />C <br />a. <br />{TATER NON RCRA HAZARDOUS L_QUID <br />SteleOIL, <br />G <br />v E <br />01011 <br />TTJ <br />C <br />G <br />EPAlOdr <br />3I N b. <br />E <br />Star <br />�. R <br />A <br />EPA/Othm <br />1 � <br />gar s <br />R <br />EPA/ONer <br />i <br />I <br />d <br />State <br />i <br />EPA/Orr <br />J. Adddiorsvl Dexygfam For Materials Listed Above <br />K HandL g Codes for Wesres Idod Abase <br />3 <br />C. <br />d <br />15. Special Handgrg rstroetians and Additional Information <br />24 HR E.*IERGEN CY CONTACT: PRC PATTERSON (800) 874-4444 <br />14 HR EMERGENCY RESPONSE: CHEM TEL, INC. (800) 255-3924 <br />WEAR APPROPRIATE PROTECTIVE CLOTHING AND RESPIRATOR <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the casements of this consignment are fully and accurately described above by proper shipping home and are classified, <br />pocked, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and narioml gm <br />ovemem regulolias. <br />If I am a large quantity generator, I certify that I have a progrcen in place to reduce the volume and tonicity of waste generated to the degree I have determined to be <br />economically practicable and that I have selected the procticoble method of beonnent, storage, or disposal currently available to me which minimizes the present and fzker <br />threat to human health and the environment; OR, R 1 am a smd quantity generator, I have made a good for effort to minimize my waste generation and select the best <br />waste man t method that is amiloble to me and that 1 cm afford. <br />p' °�/Typed Name c%eU �' rs � r = t SigvN - G <br />Month Day years <br />JllkM E.S I:DSa.iis GLS n/l an (C �\ r.� ?.1t�r.'.'c h+N to P <br />1 f/ <br />y <br />17 r I A of ReIcei t of Material, <br />A <br />P' / Name <br />r,�� M, Lea, c ,�-- �— <br />rth � Cl V <br />Is <br />18. Tr r 2 Ackna of Recei t of Material, <br />rPrimed/Typed <br />e <br />Name / swaluee <br />March Day Year <br />19. Discrepancy Indication Space <br />IF <br />A <br />C <br />1 <br />L <br />I <br />20. Foeilits, Owner w Oceurzkor Cenifscation of receipt of hazardous materials covered by this manifest accept ce nosed in Items 19. <br />T <br />' Printed/Typed Name Signature <br />Month Da, Yew <br />Y <br />