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al Californiu4nvironmental Protedion Agency is <br /> rm Approved OMNa.2050-0039(Expires 9-30-99[ See Instructions on back of 195 Deportment of Toxic Substances Control <br /> Please llllt�nt.br type_ Form designed for use on elite 112-pi")lypewrtter. Sacramento,California <br /> I. Generators US EPA ID NoManifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS <br /> WASTE MANIFEST <br /> CAT 0 8 0 0 1 9 9 4 618 2 1 O 5 of 1 is not required by Federal low. <br /> 3. Cjj7jt!jjypyp achd.28railing Address /1 ' ''Monifesl Document Number 2 29 7 <br /> PO BOX 5095, ROCH #M= 9.!;-Generators ID <br /> tSAN RAHM CA 94583 G'S 6L <br /> LO d- Generator's Phone I l - <br /> 'ITS. �$ff*Transporter's M[Re - - <br /> ter G. US EPA ID Number _- <br /> F&MMIATION, DIC. C A D 016-131 5 4 7 9 9 6 spotter's Phare <br /> m 7. Transporter 2 Company Name 8. US EPA ID Number ; {#rpnspwt4rs 1DReserred.] _ <br /> x spnrMr's Phone <br /> TTd I0. U5 EPA ID Number A&1U**jt� tftg CbMlogies c� <br /> z 2081 Hay Road °iy sPha <br /> M <br /> p Fast Palo Alto, CA 94303 CAD 0 0 9 4 5 2 6 5 7 „s (415) 324—W* <br /> J 12. Containers 13. Total I4. Unit <br /> Q <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and Ip Number[ No. T Quantity Wt/Vol 1, Wo;titadtamlltri{,. . <br /> State <br /> MASTS PLANNAR K LIQUIDS, N.O.S.(UNLM, DIUKII), 3 0111993 PCII , <br /> RO (DO18) >;IBI{128} 0101 , T T /� G EPA/011ier MO <br /> 3 � <br /> State <br /> E <br /> 1alb 6 EPA/016er - <br /> -4CV R - State <br /> •� A e <br /> m <br /> O EPA/Ot6er <br /> I � R <br /> Slate <br /> w d. <br /> r <br /> Z EPA/Ot6e, <br /> t Uj <br /> V 5 -1iJaejdling Codes far Wastes tided Above <br /> z <br /> j'� art ' i <br /> vj . :�a,-T' 3 .`�.gv 7 <br /> eta d <br /> 15 Special Handling Instructions and Additional Information Y d vJ�5 j �C[„y�r,J AVC <br /> SN 00 WPONSK CALL (1001 947-7701 'fit O <br /> z S,jJo-JYI1r-I c-A <br /> W <br /> J 1 S. GENERATOR'S CERTIFICATION_ 1 hereby declare Thal the contents of this consiggnment arch Fully and accuratelyy described above by proper shipping name and are classified,packed, <br /> marked,and Ia6ele4,and are w all respells in proper condition for transport_6y h'ghway according to app4ica6le international and national government regulations. <br /> If f am a large quantity generator,1 certify that I have a pr ram in place to reduce the volume and toxicity of waste generated to the degree I have determined la be eco It <br /> ii practitable and That I have selected the practicable me"od of treatment,sWrage,or disposal currently available to me which minimizes the present and Future threat to human health <br /> i cn and the environment;OR,if I am a small quantity generator.I have mode a good faith eFfoA to minimize my waste generation and select the best waste management method that is <br /> cK availo6le to me and that I con afford_ <br /> O Sign a Month Day Yea <br /> >- Prin /Typed Name <br /> Nrans <br /> V 3 olu1 Acknowl ement of Recei t of Materialsa SignaturMonth Day Yec <br /> w - / Z O O� PB2 Acknawled erneN of Recei t of Materials Month DayO rnypame Signature <br /> Uj E <br /> Q R <br /> (..1 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> rinl� <br /> ati[iOwner or O rator Certification of recei t of hazardous 7177 <br /> his manifest exce t as noted in Item 19 µ0nDay Ye <br /> Yd/Typed Nome �� <br /> DO NOT WRITE BELOW THIS LINE. <br /> Wk." T5D` SENDS THIS tiOPY f0 D35C WITHIN 30 DAY` <br /> DTSC 1}022A(1/991 To_ fi.r 30� ��f1Q. Sacrnmerto. CA 95812 <br /> EPA 8700-22 <br />