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--— — Deperim"of Hallo aervic« <br /> Slat,of C..'4ilom,.--�Malm and Weltue Agency TOAk 3,gat,ocae Control DMaba <br /> torn,oprosed OUS No 2080-00.'fY(Emwes W30-JM calSaNa <br /> .�Please riot or am des ,or use oa elk . (WiKetor'a 119 EPA ID No. Wnaa&t PAse <br /> UNIFORM HAZARDOUS "� t hlogeatonIn,tl�. Irtlaa ''"' <br /> WASTE MANIFEST CAT 0 8 0 0 2 9 1 6 st °Ot mens GiO�ev l"" <br /> \l 3. Ganaratoi s Nem&AN Mauling Address A' �4 M S _ <br /> Pacific Bell $ Environmental Management 8799 <br /> 2600 Camino Ramon, Room 2EO501 San Ramon, ca.94583 e. slate G.nst.t«s 10 <br /> &. Generator's Phone(916) 9722417 Attn: Steve Wat H Yj H Q 3161011 1 9 <br /> p6. US EPA ID Number C. State Traroporter's ID v <br /> �tf 5. Tnnsponu t Company Name <br /> N D. Tnasp f f Prion <br /> T. Traneporter 2 Companyf Name S. US EPA ID Number E- state Treaepoaa/ <br /> F. Traeeporlai a Phar <br /> 9. Ds&Qnstad Facility Name and Site Address t0. US EPA ID Number 0. Bute Facility's ID <br /> ,4 It Stf fP $��� c� - e 1 <br /> Facility's Phar <br /> < - 0 <br /> 2 12, Containers 13. Total 14. L <br /> it. US DOT Description(Mcluding Proper Shipping Name.Hazard Claes,and ID Number) Quantity Unit Waste No. <br /> LL No, Type Wt/go <br /> 7 state <br /> < _ <br /> G �r'PY / O1�s�L _rAn/yL ,v7) <br /> EPA/ <br /> s E79 <br /> N 1 t✓ �c ✓ _ T state <br /> E o <br /> m A EPA(Othr <br /> m T <br /> Slat* <br /> a R c <br /> g - EPA/Oltrr ' <br /> ¢ d state .. <br /> w <br /> w FPA/pea <br /> w <br /> U <br /> w K. Handling Code@ fa West"Listed Above <br /> d <br /> N Additional Descriptions for Matenals Liated Above '• J <br /> a GJ� pr� LN�Ltiq�JJN[).�G —SGL 7s1x/K a. b. <br /> to w,T M- i SSS T N 4 W 9 coca aw e—,S c D:M-LG. d. <br /> Al TA A <br /> z <br /> O15. Speci&1 Handling Instructions and Additional Information <br /> z Pacific Bell UE-148 <br /> to NDN C Redwood and 6tn Street <br /> 3to^ ton Ca. <br /> J <br /> J <br /> < 8. <br /> U <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping <br /> name and are classified, packed, marked, and labeled, and are in all respects in proper condition Ior transport by highway according to applicable <br /> J international and national government regulations. <br /> a <br /> m that have a program in place to reduce the volume and toxicity of waste generated to the degree I have <br /> II 1 am a large quantity generator, I certify <br /> ¢ determined to be economically practicable and that ) haveselected the practicable method of treatment, storage, or disposal currently available to <br /> 0 me which mimmaea the present and future threat to human health and the environment; OR, A I am a small quantity generator. I have made a good <br /> )- faith effort to minimize my waste generation and select the beat waste management method that Is available to me and that I can afford. <br /> U <br /> w Printed/Typed Name - Signal , Month Day Yea, <br /> (9 <br /> w a Tom rI Ce <br /> W17. Transporter I Acknowledgement of Receipt of Matenals <br /> R Sipnsluro Month Day Year <br /> 2 A Printed/Typed Name <br /> ¢ N �j <br /> LL S <br /> P 18. Transposer 2 Acknowledgement of Racerpt of Maleneb <br /> O <br /> w Signature Monts Day Veer <br /> m R Printed/Typed N&me <br /> < T <br /> U E <br /> Z <br /> - lg. Discrepancy Ndketion Specs <br /> F <br /> A <br /> C <br /> 1 <br /> 1 20. Facility Owner a Operator nhication of ragipl of hazardous matenals covered by this manifest ex' d in"- 19. <br /> T Prinud/ am& Spnal we - Monm DAY Year <br /> or <br /> oN8 8022 A(1187) White: TSDF SENDS COPY TO DOHS WITHI YS IONS ON THE BACK <br /> EPA BT00-22 <br /> To: P.O. 3000, Sacramento, CA 9581 <br /> (Rev.9 BW Previow sdibons ars obsolete. <br />