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State of California-Environmental Protection Agency <br /> arm Approved OMB No.2050-0039(Expires-9-30-99) See Instructions on bock of I] a 6. Department of Toxic Substances Centre <br /> lease print or type. form designed for use on elite f T2-pifch[ r. Sacramento,California <br /> UNIFORM HAZARDOUS I- enerator's US EPA tO No. Manifest Document Na. 2. Page 1 Information in the shaded areas <br /> E. Q is not required by Federal low_ <br /> WASTE MANIFEST J <br /> 3. Gene 's Name and MailingI Address A. Stait10 Manifest Document Number <br /> - 19ss <br /> , �"iefteraior's 1D <br /> �r� <br /> 4. Generator's Phone ){w ( - ` '�� <br /> $. Transporter 1 Company Name`L r 6. US EPA tD Number ' -'Ti+yitsporier`s 10[Reserved.] <br /> co �: <br /> o ECf)fO V Control fndl.Tstries 0131011 7 Tr9asporeefs Phone <br /> 59,£x-236 93 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number 'StaC>iE lrroitsprxtcr's ID(Reserved.] <br /> Q € Trwtspgster'a 6-- <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G kstaFaict'ittxs <br /> .11311.`'. CI err.{I;gl (. ol-00'ratio11 3' <br /> +h; <br /> 2u$'+ Bay Fuad <br /> ane'ivi <br /> East Pala Alto CA 943036Jr` 7 .:',- 6. <br /> 4 1 , <br /> 11. US DOT Description(irtcfuding?raper Shipping Name,Hazard Class,and ID Number) <br /> 12. Containers 13. Total I4. Unit <br /> Na. T pe Quantity Wt/vol t- W¢yte*rnf;ei <br /> G EPAjOdser <br /> Li PTr <br /> N b* W Tc f= Ar+1~3" j,)jV j 4p5j /111.0. S. 3JG014?3 v State <br /> co E {GA�a�ti�set % 1120 Zt3 : <br /> R Daol,Dole >� / PAIOther <br /> A0001,0019 <br /> T c. sore <br /> ED O <br /> R <br /> d E State : . <br /> U EPA/C]Ifser <br /> w <br /> .. <br /> �(? piwsi; i6c+irK�5[s LrAbove K. Handling Codes for Wastes listed Above <br /> RET-Pol_Eum HYDROCARBONS 700A,100% <br /> Lu <br /> WATER 0%-30% d. <br /> T55 5 ecial HandlingInsfruj:ion esnd Additional Inform tion <br /> 1r 21 lC}Iarl re equlpmen$ t:�J` I{�I? S 0' Vv 1fTtc�c ?"c^ t1C lvtrnarn <br /> Z 1�# rloui t?rrtergaf�,ry iiurlb�r. I 4!G 7`� 7 -7 S i TE L 0 0 A T 13f�: me/l-'UM <br /> 24 hour ewer en4 cantac t: 8�. I"1 <br /> 1 Q1=R t OLS e_- <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this constynment are fully and accurately described above by proper:hipping name and are classified,packed, <br /> marked,and labeled,and are in all respects in proper condition for transport 6y highway according to applicable international and national government regulatians- <br /> If I am a large gvontily generator,I certify that I hove a preyyram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> practicable and that I have selected the practicable method of heutment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> rx and the environment;OR if I am a small quantity generator,I have made o good faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> Print d/Typed Nome Signa e r 7 - Month Day Year <br /> LLj <br /> +� �x,t,JS <br /> R <br /> T 17. Transporter 1 Achnowted ement of R i I of Materials <br /> en <br /> A d ay Year <br /> PrinteT Si <br /> N - <br /> S <br /> P <br /> D 18. Trans iter 2 Ack cute merit of Receipt e Maferiols <br /> RPrinted/T <br /> u.r f Yped Nome r Signet MonthDay Year <br /> R <br /> 19. Discrepancy Indication Space <br /> A jf �t l � � F-' 44-e- lUan �'r yr �Y �2 [ CZS ] � lX1CS e�#nc Co f` c!r — <br /> f ( 3 <br /> ' I 3 L r)'L� 3 e !1 trti +zs !J'2 O r3� l Cd"' <br /> I. <br /> 1 20. facility Owner or OpLraJw Certification of receipt of hazordous materials covered by this manifest except as noted in Item t 9. <br /> T Printed/Typed N Signature Month Day Year <br /> ' DO NOT WRITE BELOW THIS LINE- <br /> TSC 8022A(i/99f white TSOF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> A 8700-22 To P.O- Box 3000, Sacramento, CA 95812 <br />