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i <br /> State of Californiq—Ernriygp mentol Protection Agency <br /> Form Approved OMB N x 050-0039(Expires 9-30-99) See Instructions OD back C 19e 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-piKrwrifer. Sacramento,California <br /> UNIFORM HAZARDOUS Generator's US EPA ID No. M fest Do ument Na. 2. Page 1 nformation in the shaded areas <br /> WASTE MANIFEST 22 of required by Federal law. <br /> CAD 9 8 1 9 7 6 2 2 8 � .J <br /> 3. Generator's Name and Mailing Address A. Stake Manifest Document Number 24693441 q <br /> BIO VALL"PORE 4 6(�/j A v J 3 z{ j <br /> 3282 Auto Cmdw Cerello <br /> O 8toalklon, CA 85288.8388 as B. State Generator's ID <br /> nA. Generator's Phone I12881188&82" <br /> N 5. 6. US EPA ID Number C. Slate <br /> ! h rC€Y'9 SfIfPP�is 1@ientat eGtral gies Transporter's ID[Reserved_) <br /> O C Al010191415121615 7 D. Transporter's Phone 650/324-1638 <br /> O <br /> m 7. Transporter 2 Company Name 8. US EPA ID Number E. Slate Transporter's ID[Reserved.[ <br /> F- Transporters Phone <br /> Md <br /> P�(4NM9 "` `eFi�Fi�menP'Phnolog6es 0. Us EPA ID Number G. State 111111111121115 7 <br /> "e)z 2081 Say Road H. Facility's Phone <br /> 4tio Eds1 Pala Aiia, CA 94303 1 01019141312161517 G501324-1638 <br /> �Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> 3 No. Tye Quantity Wt/Vol L Waste Number <br /> r z a Uther regulated substances, liquid N.U.s.Ut State343 <br /> 3 G NA 3087, P6111, Rte, Contains Ethylene Qlvcol 0101 , T ' EPA/,NONE <br /> PA/ T!Y ONE <br /> E b. <br /> o N stare <br /> m E <br /> a R EPA/Other <br /> v A <br /> O T State <br /> m O <br /> R EPA/Olher <br /> F d. <br /> State <br /> Z <br /> w <br /> V EPA/Other <br /> w <br /> 1AffSnSZ e yffBMiatteri srecd AV aK.. Han# Codes for Waste Listed Above <br /> b. <br /> w (14ntifYAeaA� <br /> m d. <br /> a <br /> Z 15. S ecial Handling Instructions and Additional Information <br /> stows and Peefet_tivo Clothing Emergency Response Phone! 800[756-:4248 <br /> Z ROMIC Profile #201fi1f Emergency Response Guide Book #1711 <br /> ) W <br /> H <br /> ' 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of thisc sign ent are Fully and accurate]Y described above by proper shpping name and arc classified,packed, <br /> V marked,and labeled,and are in oil respects in proper condition for fr sport y highway according to applicable internafianal and not ship <br /> .government regulations. <br /> If I am o large quantity generator,I cediy that have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economicallyy <br /> vat prooticab]e and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and furore threat to human heahh <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 /> o' <br /> available ro me and that I can afford. <br /> O <br /> } PpntedITI Name ` Signature <br /> L) I \\lNnny nB� Day Year <br /> w 17. Transporter 1 A<knowled emenl of Recei t of Ma rich <br /> Z= A Printed/T ped Name Signator j Month Year <br /> W <br /> _ �� J� f� 13'k/Y o <br /> W 0 18. Trans der 2 Acknowledgement of Receipt of Materials <br /> O T Printed/Typed Name Sign re Month Day Year <br /> W E <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> G <br /> I <br /> L <br /> ( 20. Facility Owner r Operator Certification of receipt of hazardous materials covered by this mar', exce t as nal in m 19. <br /> T Printed/Typed Wgie Signature /J Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A(1/99) (Generators who submit hazardous waste For transport out-of-slate, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />