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eof Califomia Environmental Protection Agency <br /> Approved OMB No-2050-0039(Expires 9-30-991 See Instructions on back of p Department of Toxic Substances Control <br /> or type -"arm designed/or use on erite(I 2-pitch)type* - 195 <br /> Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal low. <br /> WASTE MANIFEST C A T 0 8 0 O 2 1.3 51 -51 2 0 9 9 of 1 <br /> 3. Generator's Name and Mailing Address `7' 's �einfr9ru ber <br /> PACMIC , _ , 22'0. 9 61 <br /> PO 80X 5095, ROM #3EMO <br /> !���n�� pp]],����,�(ON CA 94583 (725)-F23— <br /> '4 +qy -- <br /> 4. Generator's Phone T'"�' W - (72 �F23— <br /> y �Pe�r�ATEON St 6. US EPA tD Number Stets q` x. 48 <br /> RFilIDIATION, INC. C A D O 6 3 51417 9 916 <br /> }258 1196 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number <br /> 9. Designated Facility Name and Site Address s t 10. US EPA ID Number <br /> .5 E (ALT F.4e-1 l-r T-)'- <br /> -2081-41— <br /> )'- <br /> t <br /> I 1. U$DOT Description(including Proper Shipping Name,Hazard Class,and]D Number) <br /> 12, Containers 13. Total 14, Unit+ <br /> No. Type Quantity Wt/Val .� _ <br /> _ IIASTE FLAIIa"11 LIQUIDS, X.O.S.(GASOLINE, DIESEL), 3 DE1993 PGII <br /> RQ {11018} BIGM 28) <br /> E O to T T G <br /> N b. ' <br /> 3 <br /> R <br /> T `_ F <br /> i O g t <br /> R - <br /> d <br /> i <br /> ?"fid- •,y s.,..y� ��� - 4-!'. � ty�- �r t r _ ,{,F,'��,�pa--. <br /> J 15_ Special Handling InstrUctions and Addirm.o)Information A�►�R 5 5 Z6 Z <br /> EIERGENCT RESPONSE CALL (800( 947-7701 <br /> ( 16. GENERATOR'S CERTIFICATION: I hereby,declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> 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 am a large quantify generator,I certify that I have a pr�ram in place to red-ice the volume and toxicity of waste generated to the degree I have determined to be economically <br /> i pructicable and that I have selected the procticoble method of treatment,.storage,or disposal currently available 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 made a 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 Typed NameSigna \ Monts Da Year <br /> 1 ilk CQo ,r <br /> i <br /> 1 17. Transporter 1 Acknowledgement of Rec!i t of Materials <br /> R - <br /> A Pren /T ed Nome $i na <br /> N : g Month Day Year <br /> s 12 2— <br /> P <br /> 0 18. Trans flet 2 Acknowled ement of Receipt of Materials <br /> t T Printed/Typed Name <br /> ame Signahare Month Day Year <br /> R <br /> F <br /> 19. Discrepancy Indication Spoce <br /> A ;Xr Ke," Y,vrp'Nq <br /> 1 20. Facility Owner or O erator Certification of recei t hazardous materials covered b this manifest except as noted in Item 19. <br /> T Printed/Typed Name - Signature <br /> Y Month Day Year - <br /> DO NOT WRITE BELOW THIS LINE. V Z Z 3 <br /> C 8022A (1/991 White: TSDF SENDS THIS COPY TO DISC WITHIN 30 DAYS. <br /> 87GO-22 To: P.O- Box 3000, Sacramento, CA 95812 <br />