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rte _ <br /> Store o(Cafilprnia—E nvironmasho(PTp ay'~ <br /> Farp Apprared OM8 No 28500()39{Es�iresx9q' 6195 <br /> Please rind See!nsl�uttions on back of Department of Toxic Substances Contrc <br /> P ar type. Form�tBrnled�use qn,�Ae:f t I-pitch)typew!ri7er. � pa <br /> Sacramento,California <br /> UNIFa s.0 EF rd Hetes Dace en1 2. Pvgei Information in the shaded oreos <br /> �x ~S 2 is not squired by Federal low. <br /> WAST 14NIES� of <br /> 3- Generalot"s(`{avis and Mailing Address 4t4 X1gwfTast Docvmen!Number <br /> F�FID .22495564 <br /> rt#+] O�Sfa�2(3i�tNerafiors fD <br /> A. Generator's Phare . CA %-'W3 ygy�� 16 6 b <br /> to { & 6. us EPA b t fumfxr She 1Irsporter If)[Re <br /> r %• r C I A D Q 1613151417191916 Tra�s�tirtels Itlaae <br /> j268-1196 <br /> T 7. TronsPorter 2 Company Nome S_ US EPA 0 Number .Flzuss vrler's!Q Rescrvad_] <br /> J. <br /> 4. Designated Foeefi �Igtns and Site Address 10- US EPA 16(unite r <br /> RaKic Emvi dal Technoiogies <br /> l 2081 Hay Road ;x"tea <br /> ,Fast Palo Alto CA H303 Al] O O 9i 4 5 2 6 5 7 ?,�L-11. 324- 63t3, <br /> 11. US DOT Description(including Pr 12 Containers 13. Total 14, <br /> Unit <br /> open Shipping Names,Hazard Close,and ID Numbarl .. <br /> Z a No. Type Quantity Wt/V-1 I. WYpsle Number <br /> sen FLAMM 11Q1103' I.O.S.GRO [sl�(IIr�, Dun), 3 ®I9113 !Qr srSr <br /> EE1900 ri T T EPA/Other <br /> b. <br /> m E Stgte <br /> R FPAIOther <br /> A <br /> m O c state <br /> R EPAf©cher <br /> d. <br /> Z _ state <br /> w <br /> V <br /> - EPA/0Iher <br /> r 1t: Handlire <br /> g Codes for Wastes Listed Above <br /> CLt <br /> d <br /> O IS. Special Handling Instructions and Additional Information ` <br /> K=GW Rf;5POSB ULL (100) 9117-770I 1T Ir +fit-P3>R iS (iO 60 l is v kA '>`T. <br /> �Hr_1 maks� CACIT <br /> 16. GENEIIATOR"s [ERTIFICATION: 1 hereby declare that the contents of this cons+'gnment,are fully and accurately described chore by proper shipping name and are classified,packed, <br /> marked,and labeled,and are in OH respects in proper condition For transport by highway according to applicable international and national government regularions. <br /> f(Y am o large quantity generator,1 certify that 1 have a engram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> N practicable and that I have selected the prochcoble method of treatment,ytotags,ar disposal cunendy available to me which minimizes the present and future threat to human heahh <br /> and the environment;OR,if 1 am a sma 11 quan9ty generator,!(rare made a gaud Foi11e e(forF <br /> available to me and that I can offord. best waste minimize my waste generation and select the bewaste manogemenl methal'fiat is <br /> r Ac nowt <br /> Z <br /> Printed/ No a Sign Month Day Year <br /> Q <br /> U-1 T <br /> R A- <br /> 17 Trans eement a ecei t of Materials <br /> A Printed/ Namej Sigrratur <br /> M � iJ Month Day Year <br /> w 0 18. Transporter 2 Acknowled ement ecei t of Materials <br /> L<: <br /> © T Printed/Typed Name Signature <br /> E g Month Day Year <br /> A <br /> 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> ' C <br /> f <br /> L <br /> l 20. Facih Owner or Oerator Certification of recei t of hazardous materials wvered b this maniFest exce t as not in item 19_ <br /> T Printed/Typed Name Signature <br /> ' v ` Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> SC 8022A (1/991 White. T5DF SENDS THIS CCFPY TO DTSC WITHIN 30 DAYS. <br /> A 8700-22 To: p.(� Box 3000. Sacramento, CA 95812 <br />