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Te of California—Environmental Protection Agency <br /> rm Approved OMB No.2050-0039(Expires 9.30-991 See Instructions on back of <br /> ease pant or lype. form designed for use on elite(12-pitch)"A- 066195 Department of Toxic Substances Contra <br /> Sacramento,California <br /> Fr- <br /> MWIM011 <br /> RM HAZARDOUS 1' G'enerator's US EPA 1D No. Manifest Document Na. 2. Page 1 Information in the shaded areas <br /> STE MANIFEST C A T O 8 00 1 9 2 9 2 8 2 1 1 8 1 is not required by Federal law. <br /> of <br /> C 4A1113,11 rng Address Y <br /> Em 5095, � Ro-� > 36 0,0,) :0 9 5 5 83 <br /> MN A- Cenerotar`s Phone CA 94583 <br /> N r & US EPA ID Number <br /> h. <br /> M. CAD063547996 'rte <br /> } 683196 <br /> 7. Transporter 2 Company Name B. US EPA 10 Number <br /> s : <br /> ,k Desjg`nal F 1jly ase andSite ttlddres���� �s 10. US EPA 10 Number x �� � -. .. - <br /> Z 2081 Bay Road �} ¢h <br /> East Palo Alta, CA 94303C A D O O 9 4 5 2 6 5 7 <br /> _ + 6J$ <br /> 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> z <br /> No. T Quantity Wt/Vol L Wast.Number a 6ASTE FLImB1r6 LIQUIDS, I.O.S.(CHIN, DIBSKLI, 3 01993 PGII <br /> RQ (6418) Kinf128} <br /> G 213 <br /> tv 'IV b. <br /> B A T T At G DOa3. <br /> $ '..E Site <br /> R <br /> A �Q: ocher <br /> o T <br /> coo O <br /> R t�iVCir1'�er <br /> d. <br /> Z <br /> w <br /> ��l E>iA/C,tlier <br /> CL } y Y s a k <br /> ' n n N' <br /> O 15. Special Handling Instructions and Additional information I- <br /> =MCI 111SPOASE CELL (800) 947-7701 'S +�� f���`iy :. C1p 5� <br /> -�Nij Ott <br /> I& GENERATOR'S CERTIFICATION: t 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 nafionaf government regulations. <br /> FL If 1 am a large quarvtii(y generator, <br /> It•'certify that t have a program in Place to reduce the volume and toxicity of waste generated to the degree I have determined to be economic a11 <br /> LO practicable and that f r aV0 SeleC rr�e practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future t6eat to human heallfs <br /> and the environment;OR,if I am a small quantity generator,I have made a goad 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 /> Pr' I. /Typed Name / Signature Month Day Year <br /> Uuj p Ns > ' g �. r a a <br /> T Trans Aer 1 Acl<now emenl of Receipt of Material: <br /> R <br /> la <br /> It Printed/Typed Name Si <br /> L J_ Fdoai4, Doy Year <br /> P '� DtfGA 7 (J/R/' 1 2 2 3 a 'Z <br /> �- 0 18. TraftsE2rfer 2 Acknowledgement of Receipt of Materials <br /> T Printed/Typed Name <br /> Signature <br /> E Month Day Year <br /> It <br /> u 19- Discrepancy Indication Space <br /> Z f <br /> A <br /> C <br /> 1 <br /> L <br /> } 20. Facility Owner or gb2erutor Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name y' Signature �'� <br /> Y / �m. Month Day Year <br /> l Z � C, <br /> DO NOT WRITE BELOW THIS LINE. <br /> 'C <br /> B022A II/991 While_ 15DT SENDS THIS COPY TO OTSC WITHIN 30 DAYS <br /> - <br /> A 8700-22 To P.O. Box 3000, Sacromento, CA 958 i 2 <br />