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of Coli Fornia--Ei-ironmental Protection Agency <br /> Approved OMB Na.2050-0039(Expires 51-30-99)-p Deportment of Toxic Substances Control <br /> W.seprint ortype. form designed for use on elite 02 i1ch)1y1-* See Instructions on back of p*M195 S-cromenso,Colifwflio <br /> UNIFORM HAZARDOUS 1- GO"erat0eJ US EPA ID No, Manifest Document No. 2. Page I Information in the shaded areas <br /> .1 ' WASTE MANIFEST C A T 0 8 0 0 2 8 4 4 2 8 2 1 2" 0 of is not required by federal law, <br /> 3, Generator's Name and Mailing Address <br /> PA=C FW-1- <br /> PO BM 5095, ROM EXW <br /> #3 <br /> 4. Generator's Phone OM IRA" CA 94583 65 423- -Wb <br /> 6. US EPA ID Number 5bee L' s FET <br /> j­ <br /> F&MMTATION, M. <br /> ____[CLAP.?JIDIOI 613151417191916 <br /> 7. Transporter 2 Company Name <br /> 8. US EPA ID Number <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> Rcuic EhvirA74ftentai 7tchmlogies <br /> Z: 2081 Bay Road .. ............... <br /> East Palo Alto, CA 94303 <br /> IqAIDIOIO19141512161517 <br /> 11. US DOT Description(including Proper Shipping Home,Hazard C6St.and ID Number} 12. Containers 13. Total 11- Unit <br /> No. Type Quantity WtNol P Hum <br /> Z a- <br /> WASTE ILMULK LIQUIDS, I.O.S.(GMIU, ERM), I U1193 Nil <br /> RQ (D018) 120(123) <br /> T T G EPA/Oilier DolylL <br /> E <br /> ,4 6. <br /> b N Wle <br /> Do E <br /> A <br /> 6 T <br /> 0 0 <br /> R <br /> d. <br /> S'to <br /> Z <br /> EPA/Ofher <br /> $$Oi 1.,.Listed A6,,.. <br /> it <br /> Iv;- <br /> Ila <br /> V) <br /> cfi <br /> 0 15. Special Handling Instructions and Additional Information <br /> KMCDCT MINSK CALL (1100) 947-1701 -300 V ,J K <br /> A A r CA <br /> 16. GENEwrolt*s cERTiFICATKft I hereby declare tficif 16 contents Of this conitift" 'are Fully and accurately described above by proper s6iFTngome and are classified,packed, <br /> marked,and labeled,and are in all respects in proper condition for tron .-- a government <br /> way according to applicable international and nation regulations. <br /> If I am <br /> large quantity generator,I certify"I ka:m:,LPrj" <br /> 0 I k.=P6C0 lo�tm&A�ok-the volume and toxicity of waste generated to the degree I have determined to be economicolzl <br /> practicable and that I �e selected the practicable 9r,disposal currently mailable to me which minimizes the present and Future threat to human h" <br /> and t6 environment;OR,if I am a small quantity geoerafor,t hcivv=60:=I <br /> ila6lo to me and that I can afford. <br /> Printed Name effort to minimize my waste generation and select the hest waste management method that is <br /> wettable <br /> va14 a . . --- month Day Year <br /> WE y0sr. YIV- <br /> 17. Transporter t Acknowledilevient of Receipt of Materials <br /> ire Month Day Year <br /> Printed/Typed Name <br /> e . 1 7 1 <br /> 0 1 S. Transporter 2 Acknow6d isment of Receipt of Molvirich <br /> Printed/Typed Name SignnfuroMonth 0-ay year <br /> T9 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> L <br /> 1 20. Facility Owner or 0j=Fa*r Cerlih <br /> gZ&a*,Cerlih est except as noted in Item 19. <br /> Crlih ti of receipt of hazardous materials c <br /> T Printed/Ty grtature Mon 1h Day Year <br /> y <br /> (' -I- <br /> :3 ci 161 <br /> DO NOT WRITE BELOW THIS LINE. <br /> TSC8022A(1/99} Wkqte TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS- <br /> PA <br /> AYS <br /> IP' 8700-22 To P.O. Box 3000, Socromenlo, CA 95812 <br />