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•I Stele of�olifermia—Environmental Protection Agency <br /> Fvrnr7.pproved OMS No.2050-0039(Expires 9-30-99) - See Instructions on back e' -toge 6ox <br /> . ,/ Department of Tic Substances Control <br /> i Please print or type. Farm designed for use on elife(12-plk twriter, r Sacramento,California <br /> UNIFORM HAZARDOUS G'enerator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded.,.as <br /> t / j is not required by Federal law. <br /> WASTE MANIFEST CAD 9 8 1 9 7 6 2 2 B f 1af 1 �/ <br /> 3. Generahar's Name and Mallin Address 'A. State Manifest Document Number 24691771 <br /> � /( � 1 t 7 <br /> dlO V9LLLRY FORM, G 4 <br /> 3282 Auto C"Iber Chola <br /> n Stockton, CA 852848898 116 B. State Generator's ID <br /> N d. Generator's Phone ((289))9965244 <br /> h5 Trans iter 1 Company Name 6. US EPA ID Number C. Slate Tramporter's ID lReserved.] <br /> W �. AIC Environmental TeChnologies <br /> OD. Transporter's Phone 650/324-163$ <br /> o� C A p 0 0 9 4 5 2 6 f 7 <br /> rr 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> F. Transporter's Phone <br /> L_'"•`l' 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility',ID <br /> e-la ROMiC Environmental Technologies CAD 0 10 19 14 15 12 1615171 <br /> CDzw 2081 Bay !toad H. Facility's Phone <br /> LL <br /> Etat Palo Alto, CA 94303 IC JA ID IG 10 19 14 15 12 6 15 17 6501324-1638 <br /> J <br /> G a 11. US DOT Description ludin Pro Shipping Name,Hazard Class,and ID Number 12. Containers 13, Total IT Unit <br /> / p lint g per ppi B I No. Type Quantity Wt/Vol I. Waste Number <br /> Z a. <br /> State <br /> Other regulated suDs'tances, liquid N.O.S,S 343 <br /> 3 E NA 3081, P0111, RQ, Contains Ethylene ®tycol T EPA/Other <br /> b. D 0 1 T . NONE <br /> o N stare <br /> co E <br /> < R EPA/Other <br /> a A <br /> 6 T z. Style <br /> 000 O <br /> R EPA/Other <br /> w d. State <br /> Z <br /> Z <br /> V EPA/Other <br /> W <br /> J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> ZW <br /> g ia%Ae Ethylene Glystil a. 01 b. <br /> fAnWraeze) <br /> c. d. <br /> J <br /> Q <br /> Z 15, Special Handling Instructions and Additional Information <br /> a cloves and Protective Clothing Emergency Response Phone 8001766-4248 <br /> ZROM RC Profile 6201111 Eme enc <br /> = rq y Response Guide Book *171 <br /> 16. GENERATOR'S CERTIFICATION: I hereb declare that the contents of this,cu si nt are full and accurate) described above b hi a and are classified, <br /> i Q y y y proper s ppnsg nam packed, <br /> V marked,and labeled,and are in all respects in proper condition for kanspo(1 by highway according to applicable international and national government regulations. <br /> -J+ If I am a large ti <br /> g quon y generator,I certify thathave o program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> ypracticable and that I Gave selected the procticable method of treatment,storage,at disposal currently available to me which minimizes the present and Future threat to human health <br /> and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize myste generation and select the best waste management method that is <br /> O available to in.and that I can afford. - <br /> ZPr ted/Typgj�Nvakn \ O { s1 1 Signature Monll,l Day Year <br /> .I w A 17. Transporter 1 Acknowl em mt of Receipt of Materials` , 'y\••Jc -'` �I / <br /> w A Printed/Typed Name Signdbra j Month Day YearIs Jo A <br /> �. <br /> LL 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> O T Printed/Typed Name big urs �' Month Day Year <br /> N E <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z E <br /> — A <br /> r C <br /> I <br /> L <br /> 1 20. facility Owner or Operator Certification of recap t of hazardous materials covered by this in •t except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y A)r, gtL, / d / "/ O <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A 11/991 (Generators who submit hazardous waste For transport out-of-stale, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.! <br />