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F[aA.p'p,. <br /> alifornsa Environmental ProfecFtan Agency <br /> vOM6 No.•2054n039(Exsres 9-30-99J See'Instructions Oil back of Department of Toxic SubstancesCan..-Tnt or type Form designed lar-rile-on elite(,T_2_p#<fij typetiDl�r -- _ 195 Sacramento, <br /> California <br /> 1. Generator's US EPA ID No. `Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS required by Federal law. <br /> WASTE MANIFEST _ _ _ ._.--.- <br /> is not r <br /> GAT08OO263138 2 O 9 3 1of .1 <br /> T. Generotars Nume and Mailing.Address - - }33acuinenf Num Ger f - <br /> PACIKC �. fYy tt r 2 © 9:5 5 5 <br /> PO _ <br /> BOX 5095, ROM #3MO0 <br /> d. Generator's Plione MN ILWN _CA 94583 (925)823-8866 <br /> � L�--L' <br /> m 1 ��efT �T�ON & _ 6. US EPA ID Number l,H rase X748 <br /> REMMIMON, IN--. CADO63547996 � er <br /> (408}268-1196 <br /> 7- Transporter 2 Company Name8. US EPA ID Number 1'dte r "'s'JC33 eseryed.] - - <br /> 9.'Designated facility Name and Site Address - - 10. US EPA tD Number ( - <br /> 77 1191AIE)l A A— <br /> w l 14 <br /> t <br /> Toa . Unit <br /> 1 1 L15 DOT Description[including Proper Shipping'Name,Hazard Class,and ID Number] 12- Containers 13. - �x <br /> No. Type Cluonfity Wt/Vol ''.Wosfe °Rs <br /> i1A5Y8 FLMULE LIQifIdSr 11.0 5 {GASOLIl1Sr DIM), 3 Uk1993 PGII W <br /> G RIL;,.;UQIS}- S)rG1{128 �. _ Y:•. :tom <br /> O T o 3 G .. <br /> N h. <br /> RPa/Ott r } <br /> �T C. <br /> O ' <br /> ss <br /> ;J <br /> EPA/Other- <br /> f��,;' ;,ury tions for Mal" :aTs'}.laled'1,`bo e� " r � _ •� r :` an ��J,e�`Af i"�; �' <br /> 4 t y l- if 8 Y '�1tSL� )tii1 1 TIS 'BISOI,.: ;q-z'T r ' <br /> Ftn�Y11`Tt�r <br /> _15, Special Handling instructions and Adddeonai Information <br /> KWGESCI RESPONSE CALL (800) 947-7701 <br /> 16. GENERATOR'S CERTIFICATION. 1 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 ail respects in proper condition For transport by highway according to applicable international and national government regulations. <br /> If t am a large quantity generator,I certify that{have a proram in place b reduce the volume and toxicity of waste generated b the degree 1 hove determined to be economically <br /> n practicable and that I leave selected the proeticable method of Ireutmeni,storage,or disposal cu.rently 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 1 can afford. <br /> _ Printed Typed 1N�nf�me Signa re//yam,' 1 Month Day Year <br /> 6101-Z <br /> T 17. Transporter I Acknowled ement of Receipt of Materials <br /> HR _ <br /> Prinfed/Typed Nome signature Month Day Year <br /> s Z ©' <br /> l 9 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/T ed Name Month Day Year <br /> T YP Sgnature <br /> E <br /> R <br /> F <br /> 19. Discrepancy Indication Space �{' PM <br /> a� ;r�riaed .c.1;i ) x- P ty. <br /> A tr 1J�. + <br /> . V �I�n �n Y 1"Yt 7,X <br /> i'VC <br /> a4 €pit a V%der- <br /> b Ilk .F+)A iVAr` 02bZ57q, 46 <br /> 1 20. Facili Owner or O for Certificatio f recei I of hazardous materials covered this manifest except as noted in 19 <br /> T printed/Ty a Signature � - Month Day Year <br /> Y <br /> 7r <br /> DO NOT WRITE BELOW THIS LINE, <br /> SC 8022A[1/99] White: TSDF SENDS TH15.COPY TO DTSC WITHIN 30 DAYS. <br /> A 870 -22 To: P.O. Box 3000, Sacramento, CA 95812 <br />