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State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9.30-991 See IOstt'Uctions 011 bGC Qg6 6. Department of Toxic Substances <br /> Please print or type. Form designed for use on elite(12-p iwriter. Sacramento,California <br /> UNIFORM HAZARDOUS 1., Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFESTIL 0 4 8 8 2 8 $ 4 3 6' 0 of 1 <br /> 3. Generator's Name and Mailing Address SITE N State Manifest Document Number <br /> t�5 '2208436 <br /> CAL s � 2040 . <br /> 0 315 WjW RIM mucy, CA 953?6 B Stare Generator s ID <br /> in M rati *pa 0 S c <br /> .N 5. Transporter 1 Company Name 6. US EPA ID Number! C.;State Tronsporter's ID'Reserved,]. <br /> in <br /> 'r <br /> ao <br /> O �D 'Transporter.'d Phone <br /> O <br /> . ronspor r ompany Nome S A%Wumbir E. SttiteTeonsporter's1D'IReserved <br /> .:� <br /> J 44Transporter'i Phone <br /> U 9. Designated Facility Name and Site Address W. US EPA ID Number' aG Siete Facility`s ID <br /> 00_ C AL IES k f I k t <br /> ®O 2081 8r IOXIII <br /> Ff FacihysPhone <br /> ALL. EAST PALO ALTO, CA 94303 <br /> �Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 1 • Containers 13. Tota( 14. Unit <br /> V No. Tye Quantify Wt/Vol 1..Waste Number <br /> Z ° $ , LIQUID, (OUT State <br /> water), (pf: 348584) 133 <br /> %EPA/Other <br /> 3 G101d' <br /> 64 O N b' State. <br /> co E <br /> R EPA/Other <br /> v A c.T <br /> o State <br /> 000 0 <br /> R EPA/Other. <br /> LU d. ' <br /> State <br /> Z <br /> W <br /> U EPA/Other <br /> W <br /> 1. Additional Descriptions for Materiali Listed Above. K. Handling Codes for Wastes listed Above <br /> Z in E Lu Z- M. g, UD $. d. t b. <br /> snIt to 348564 R <br /> c. d. <br /> J ..A.. I - <br /> Q <br /> Z 15. Special Handling Instructions and Additional Information <br /> allff 551-010 Poi S 3-85 <br /> Z <br /> s <br /> Z==gway cmtaet: DELL= M (925)634-6850 WM PROPER VIYE E4'UIPMNT (PPE] <br /> J 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Umork®d,and labeled,and are in all respects in proper condition for transport by highwayiaccording to applicable•international and national government regulations. <br /> If I am a large quantity generator,I certify that I have a pr ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be eco nomical1 <br /> n practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human heo14 <br /> and the environment;OR,if 1 am a smaquantity generator,I hove made a good'faith effort to minimize my waste generation and select the best waste management method that is <br /> oe available to me and that I can afford. <br /> 0 <br /> } Print y e kils �� Signotur Mon Do Ye <br /> 61ll IS 16Z <br /> w RT ^TrterAcknowled ement f R cei of Materials <br /> w p e Signature Month Day Ye <br /> WS <br /> Wu. 0 A( iement of Receipt o ateriols <br /> O T Printed/Typed Name Signature Month Day Ye <br /> LU E <br /> sn R <br /> a <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> 1 <br /> L <br /> 1 T/Typeod:Zme <br /> r or O rator Certification of recei t of hazardous materials covered b �s man' st exce t as noted in Item 19. <br /> j Signature Month Day Ye <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br />