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�•, it �o--En�iranmentaf Protection Agency <br /> ed OAS No.2050-0039(Expires 9-30-99f lee Instructions on back of g� 6. Department of Toxic Substances ConYrr <br /> tat nk or type. Form designed for use on elite 112 pilchf er. 6L§5 Sacramento,Colifornio <br /> 'UNIFORM HAZARDOUS i. nerator's US EPA ID No- Manifest Document No. 2. Page I Information in the shaded areas <br /> WASTE MANIFEST C1 AlT is not required by Federal low. <br /> O $ 0 0 2 3 4 4 3 8 2 1 2 2 of 1 <br /> 3. Generator's Name and Mailing Address �es1 lldc!1+�14n�Number <br /> P� CH> 22495584 <br /> PO H= 5095, RDW #3EXW <br /> A- Generatals Phoney 94583 <br /> �te A'lZON & h_ US EPA ID Number x : <br /> '/48 <br /> REMMIATION IIs. IC JA ID 19 <br /> _L613 IS 14 7 9 9 6 40EI 2b8-i196 <br /> 7. Transporter 2 Company Nome S. US EPA ID Number <br /> - <br /> �� ear."�.�. <br /> J tri S.µBt;-•-� <br /> J <br /> IQ • � <br /> 4. Designated Facility Name and Site Address 10. US EPA ID Number - <br /> R:owic EnvirorlMMtal 7bchnologies <br /> 1 2081 Hay Road <br /> I© East Palo Alto CA 94303 ICIAIDIOIO19141512 61517L. - <br /> _ <br /> I l. US DOT Description(including Proper Skipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. UnitVF/t <br /> No. Type Quantity /Val ! W4sIe Mp qr <br /> F a 11115tH F611111BLH LIQUIU5, 1.0.S,{UMlI1$, UIHSHIr), 3 011993 PBII ° <br /> G RQ (0018) KI6#(128) 2In . <br /> E b <br /> 01o, T T �) �? G IPA/Oilier <br /> N state <br /> co E <br /> R EPA/�3ther <br /> A <br /> c State <br /> w O <br /> R EPA/Qlfser <br /> d. F State <br /> U EPA/Other <br /> w <br /> J <br /> 3- <br /> lG 444 444 r*aster Listed Above <br /> ;�---WA <br /> ce <br /> 1SSpecial Handling Inst. <br /> ructions and AddeRonal Information <br /> a BM610lCI QSSP01lI5H CdfrL (800) 147-770I <br /> t"1 FLDaltFrfiS � 20 TvvL�+,r-•� 'j 1 <br /> J <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare Ihot the contents of this consignment are fully and accurately described obove by proper shipping name and ore classified,pocked, <br /> Q marked,and labeled,and are in all respects in proper condition For transport by highway according to applicable international and national government regulations. <br /> If I om a targe quanr'rFy generolor,I certify that I have a prooggtom in place to reduce the volume and toxicity of waste generated to Ike degree I have determined to be economicallyy <br /> practicable and that f Dove selected the procticoble method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human heolth <br /> and the environment;OR, if I am a small quantity generator,I have mode a good Faith effort to minimize my waste generation and select the best waste management method that is <br /> ovoiloble to me and that I can afford. <br /> Printed/Typed Nome )61 F 0-H �'r)q K( bit/ (7'�/�'�Jt F' Signatssre Month Day Year <br /> 4?F' RaLtC�tT Dttnr J% / 2 '7 O Z. <br /> � T 17. Tronspoqpr 1 Acknowledgement of Receipt of Materials <br /> Al <br /> Printed/Typed N pme '' J signature ` Month Day Year <br /> L (`�Jf <br /> S <br /> P 6+' <br /> fJ - 0 18. Transporter 2 Acknow emenl of Recei i of Materials <br /> f Printed/Typed Name - - <br /> E Signature Month Day Year <br /> R <br /> 19. Discreponcy Indication Space <br /> f <br /> A <br /> C <br /> ' 1 <br /> L <br /> 1 20. Facility O-ner rotor Certification of receipt of hazardous materiols covered by this manifest except as noted in Item 19- <br /> j Printed ""Nam" Signature Montle Day Year <br /> Y •rte �m, <br /> .t � f is <br /> DO NOT WRITE BELOW THIS LINE. <br /> ITSC 8022A [1/991 White TSDF SFNOS THIS COPY TO DISC WITHIN 30 DAYS.A 8700-22 To P O. Box 3000, 5ocramenta, CA 95812 <br />