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tote of C®lifanria—Environmental Protection Agency <br /> A..pr.,j OMB No.2050-0039(Expires 9-30-991 See Instructions on bock of 195 Department of Toxic Substances Conlrr <br /> VC-1 print or type. Form designed for use on of to 112-pitch) Sacramento,California <br /> I. Generator's US EPA ID No. Manifest Document No. L�2. Page I Information in the shaded areas <br /> UNIFORM HAZARDOUSis not rWASTE MANIFEST C A D 9 $ 25 (� 5 8 z 1 9 o 1 squired by Federal law. <br /> 3- Generator's Name and Mailing Address A. State Manifest Document Num6er <br /> PACNIC � 22095582 <br /> PO HWC 15095 R M #3EXW s: Serie Generators ID <br /> A. Generator's Phone SM YEA" CA 94583 ) }� - $ ,(� <br /> N 6. US EPA ID Number .d State Ti'onsporfiir�s ID[x'748 <br /> 'n <a� <br /> RE24IATI0d4. II4C- ICIAID10 <br /> 6 3 5 4 7 9 9 6 trpnter<i "° f1268-1196 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number -E: State i�onsparter's @{Reaerrede� <br /> V Tratssl'Vfleriw:P{inne { } <br /> 9. Designated Facility Name and Site Address10�. US EPA 10 Number .d Sic! <br /> Fpahty'sfb <br /> _ Resit E wIrolrmental Tectuwlogies 61 S <br /> y Z 2081 Hay Road FrscdiN rl.an <br /> East Palo Alta CA 94303 ICIA �Num6er <br /> JFGII <br /> 2'16151-11: <br /> 4] 324-163.8 <br /> - 12. Containers 13. Total IA. Unit <br /> 11- US DOT Description!including Proper Shipping Name,Hazard Class,and tDNo. Type Quantity Wi/vol I. Waste Number <br /> Z a. JASTE FLMRULE LIQUIDS, 11 -AWLIB6t DISSIL)e 3 1119swie 213 <br /> GRQ (00181 IMGt(1281 s T T u r �� G EPA/Other DWI,Q N b. Stale <br /> GO E <br /> R EPA/Other <br /> A C. State <br /> 0o T <br /> co O <br /> R EPA/Other <br /> d. <br /> State <br /> Z <br /> w EPA/©cher <br /> V <br /> x v. <br /> J. stiaaa Oestri frons bar M terials Fisted' "Ta..AS'`��-''"�` • K. Handling Codes for Wastes Listed Above <br /> 4��5980�-00 �18 <br /> Uj <br /> S <br /> 0 15- Special Handling Instructions and Additional InformationTC <br /> MG®CT MPOIS$ CALL 1800) 947-1701 Ll <br /> Ce <br /> 16.. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment one fully and occuratel described above by proper shipping name and ore classified,packed, <br /> marked,and labeled,and are in oil respects in proper condition for transport high—y according 10 applicable international and national government regulations. <br /> If I am a large quantity generator,I'wth that I have a program in place to rsduce the volum and toxicity of waste generated to the degree I have determined to be economically <br /> in <br /> P <br /> and that I hove selected the practicable method of hsotmenI,storage.Or.disposa(cu rently available to me which minimizes the present and future Threat to human heahh <br /> and the environment;OR,if I am a small quantity genera r,I.hava mad a ga fuA 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 /> eg^ire Month Do Year <br /> Printed/Typed Name Y <br /> z34 f .2 1 10te <br /> Transporter 1 AAv6wled ement of Recei of Maleri s <br /> R - Signature- Month Day Year <br /> Printed/Typed Name a <br /> R <br /> LL- 01 8. Transporter 2 Acknowledgement of Recei t of Materials .x <br /> a <br /> Q t Printed/Typed Name S•gnaiure Month Day Year <br /> E <br /> R <br /> 19. DiscrepancyIndication Space <br /> Z F <br /> A <br /> fs <br /> 1 t <br /> of hazardous�10t""Si�':odvf20. Facili Ovner or O erotor Certification of ret - this manifest exce I as noted in Item 19rMonth Day Year <br /> T Printed/Typed Name <br /> Y � <br /> DO NOT WRITE BELOW THIS UNE. <br /> 1DTSC 8022A 11/991 Moe. TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br /> EPA 8700-22 Ta P O- Box 3000, Sacramento. CA 95812 <br />