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State of Colifornia—Envircinmental Protection Agency <br /> rm rovftd OMS No.2050-0039(Expires 9-30-991 See Instructions on back of -6. Department of Toxic Su6stonces ConkP.,it or <br /> se type- Form designed for use on elite J12-pikh)IYPV *96195 Sacramento,California <br /> Manifest Document No. 2. Page I Information in the shaded areas <br /> L UNIFORM HAZARDOUS CLGeneralcrr'sUSEPAIDNo T is not required 6y Federal low. <br /> I <br /> WASTE MANIFEST CAT Tj 01810101 1313181518 12 il 0 14 of I <br /> 3. Generator's Name and Moiling Address .4 <br /> PA=C EMJ- <br /> a,� <br /> 0400 <br /> 2515 SOM ORANGE AVE. ROO'7 6 V, <br /> 4, <br /> 4. r <br /> ,e,,,a,,u,,ph."IEW CA 93725 (9.RS),03 <br /> 6. US EPA ID Number <br /> ............... <br /> KO <br /> co <br /> INC. JCAD 10161315 "R", <br /> _Lo4 17 91916 .st <br /> 40 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number <br /> 'k..='�M7K <br /> 9. Designcitacf Focilj",ame and Site Address 10- US EPA 11)Number <br /> RandiaEhvir-01mmtal Teckinologies <br /> ae 2W1 Bay Road <br /> East Pal* Alto, CA 94303 ICAD 101019141512161517 , <br /> 11. US DOT VeNcription(including Proper Shipping Name,Hazard Class,and ID Number) 12. Container 13. Total 14- Unit <br /> No. Type Quantity wtiv.l <br /> Z a. <br /> UM FUMM LIQUIDS, I.O.S.(USIDLIKE, 019SKL), 3 01993 F611 <br /> C' RQ (Ma) =(128) 01011 T T 0101ftlep G <br /> 1 <br /> N <br /> co <br /> R <br /> A <br /> T c- <br /> 0 <br /> R <br /> I H <br /> d- <br /> F% <br /> ........... Additional Information <br /> MGM MPME au (Soo) 947-7701 -PI 7te Aa -?—S7/S %RV u 77,#` 01VA 40,E <br /> 16. GENERATOR'S CERTIFICATION: 16weby declare that the contents of this consignment ore fully and accurately described above 6 ,�mpr';q name and are classified,pocked, <br /> marked,and labeled,and are in all respects in proper condition For transport by highway according to applicable internationalno government regulations. <br /> IF I am a large generator,I certify that 16cr,e a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to 6e economically <br /> rn awe quantity <br /> the practicable method of treatment,storage,or disposal currently avoila6le to me which minimizes The present and future threat to human health <br /> practicable uncirt I <br /> and the environment;OR,if I am a smolt quantity generator,I have made a good faith effort to minimize my waste generation and select the boss waste management method that is <br /> available to me and that I can afford. <br /> Printed/Typed Name je7$C-7rj,4 57-nACie CV1 month Day Year <br /> to Aft FRuem-r PE'L^1 a 1 2 <br /> 17. Transporter I Acknowledgement of Receipt of materials <br /> R <br /> " Pri.%lyped?�pmre Signature month Day Year <br /> IC's Z,— - <br /> P I- (A � 1 1-2-A- --.4 2 1921 2L <br /> az a i a. Trana2rtq!r 2 Acknowledgement of Receipt of Materials <br /> 0 R <br /> I Printed/Typed Name Signature Month Day Year <br /> I0. <br /> 19. Discrepancy Indication Space F, <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Foci4y Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature meoth NY Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> SC8022A(1/991 While- TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br /> A 8700-22 To P.O. Box 3000, Sacramento, CA 95812 <br />