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State of Colifornia—Environmental Protection Agency <br /> 'Farm Approved OMB No.2050-0039(Expires 9-30-991 <br /> Please print or type. Form designed for use on elite(12 pitch) Jer. See Instructions on back o e 6. <br /> Department o!Toxic Substances Cohn <br /> --r—ento,CaCi»rnia <br /> UNIFORM HAZARDOUS Genet°tQr s Manifest Document No. 2. Po 1 Information in the sh <br /> 9e ceded ureas <br /> ,WASTE MANIFEST6, 7I is not required by Federal low. <br /> of s <br /> 3. Generator's Names and Mailing Address ■fin`8 e11 <br /> F'tl � x �tt'fy=""�S Y• <br /> Ro- 6oxSo9 Roarn 3EQD0 _ <br /> SAnRAMOA CA 94583 <br /> 1. Generators Phone 7/0 <br /> r/��jL �}y �xy��9��•.�r � �'}d .' <br /> RV 5. Transporter I Company Name <br /> sr't b. US EPA ID Number y ` <br /> Ecology Control IndustriesIAI <br /> 01310111713 <br /> sprt°1`: ane <br /> r <br /> r Y <br /> T. Transporter 3 Company Name S. US EPA ID Number .8 <br /> �rixr <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number _ <br /> R©MiC Chelt�I Corporation <br /> 2081 Bay Road <br /> © East Palo Alto CA 94303 <br /> Ap Q. 02161517` rte <br /> 11. US DOT Description(including Pro Shipping I2. Containers 13. Total ` •1 A Umt + . *i. <br /> p (' n9 pn ppine Name,Ha rd Class,and ID Numbed ?.. z <br /> Z No. Type Quantity tha/Vol <br /> AsMf249rnmAbLA L1pltb$ <br /> G t A'0'5''f' UM 19931 Pr6J)) <br /> E bQoJ ) PraF7t.''�S9E TT <br /> o H b' <br /> m E #j <br /> At <br /> T c. <br /> a0 Owr <br /> t. <br /> R <br /> d. �` > <br /> ` <br /> ILU <br /> � � •Fty:ti'e7 r� ":�.�� � r m'; 2 �,.� t o- ��. ''� ,r - s gni :''� <br /> CL <br /> Uj <br /> 5 ecial Handling Ins on.and Additional In lion ' ••� <br /> e r proper pro F FIV equipmen while handling. Weights or volumes are approximate. ERGel 1a 1281 <br /> a 24 hour emergency number:9/49 77-7 7.71 SITE LOCATION- 7),2gd U►NN501�0 <br /> fir`ve <br /> 24 hour emergency contact: rAc$jl � 1' �as�-ow C2. <br /> EQIJINSATGIS�C <br /> 16. GEN€RATOR'$ CERTIFICATION: 1 hereby declare that 16e contents of this consignment are lly and accuratef�described above by proper shipying name and are classified pocked, <br /> marked,and labeled,and are in all respects in proper condition for transport try highway according to appPicable international and notionol government regulations- <br /> If I am a large quantity generotor,I certify that I have a pr ram in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economim11 <br /> t <br /> iPracticable and;at 1 hove selected the practicable method of beatment,storage,or disposal currently awilable to me which minimizes the present and future threat to human health <br /> and the environment-OR if i am a small quantity generator,I have mode a good faith effolrt to minimize my waste generation and select the hest waste management method that is <br /> a as'a'lable to me and that I con afford. <br /> Prin. me Signa. y _ <br /> MontlY, �' Year <br /> Lulj <br /> (� T 17. T n rier I Acknowled f of Receipt of Materials �` •' <br /> S Printed/Typed Name <br /> G Signature Month Day Year <br /> w 118. Transporter 2 Acknowledgement of Receiptof Materials - <br /> 7 Printed/Typed Name Signature <br /> Month Day Year <br /> 19. Discrepancy Indication Space <br /> z F <br /> A <br /> C <br /> ' I <br /> 120, Focili Chw;or rofor ertification of receiptof hozardous moleriols covered b this manifest exce as noted in Item 19. <br /> T Prinled/Typed Name - <br /> Y Signature ^� Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> TSC 8022A(1/99) White= TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS- <br /> PA 8700-22 To. P.O. Bon 3000, Sacramento, CA 95812 <br />