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State of California—Environmental Protection Agency E S Form Approved B No.2050-0039(Expires 9-30-99) See Instructions on back OF 'e 6. Department of Toxic Substances Control Plea or type. Form designed for use on elite(12-pitchk .iter. Sacramento,California Cenefptprr��US EPA ID No.-I s";'A 6 Manifest Document No. 2. Page 1 Information in the shaded areas UNIFORM IiAZA DOS 1rwT'it - * t a is not required by Federal law. �+ + : ' WASTE .MANIFEST G Nd G C 1,8 8l1 11 0 1 6 1 0 8 ' 5 of 3. Generator's Name and Mailing Address A. State Manifest Document Number C.S.U. STAIII ISL..AUS 23534718 1252 N0R1 H S'I'ANISL.AIJS p S 1'()CK jON1 C0 95267 B. State Generator's ID W) 4. Generator's Phone 1209 473—L261 CN 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] - 0 ' D. Transporter's Phone o WOR[.D ENVIROME.'NTAL. KNERBiY INC. C1 AlR1 0101010131 -112 8 3 Q10371-36V 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter',ID Reserved.) F. Transporter',Phone ( -• Q ti U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID C�Q ALA'AMGNT I_ANDF 11.1. y/ Z 10840 AL.TAtI.1N 1 PASS RD. H. Facility's Phone n0 1..TVEi I10RL CO. 94551 1 CA D 9181 '1131812.17131 P (925)419--6349 'IQ = 12. Containers 13. Total 14. Unit • s U 1 1. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol 1. Waste Number - VZ Rig `uSEIEST'GS, 9, Nka2l2Z, P(:r11 f (NAER6141.7:1.)- °State EPA/Other E b, State E - r R h EPA/Other A c. State o' T aco O R EPA/Other CY State w d. Z V EPA/Other LU J. Additional Descriptions for Materials 1.isfed Above ° K. Handling Codes for Wastes Listed Above Z .. 0 ,�, ASSE.SSTM-WNTAIfi�IW�,.-14GII'Ffi� _ C. d Z 15. Special Handling Instructions and Additional Information 0 %'.4 'HCfIJFtS EMERGENCY #( RE61ON IX EPA RE619N 1X ZE_G1011 Z IX BAAQMD 939 E�I_LIS ST SAN FRANCISC0 CA,94109 ASbF:S'I0S RF:M0VPl... kFOUIREMENT LU 1fFJ FREti, ( 1A[3tiEDoS-f -1) 1.AItEL.F..'1)) 3a Nancea C.S.U. STAN SLAIJS, lob # '71'3 J 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and aceWately described above by proper shipping name and are classified,packed, Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. If I am a large quantiy generator,I certify that I have a progam in place to reduce the volume and toxicity of waste,gwerated to the degree I have determined to be economically a practicable and that I have selected the racticable method of eatment,stor4e,or disposal currently available to me which minimizes the present and future threat to human health rn and the environment;OR, if I am a sma I quantify generator,I ve made a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford. OPri fed/Typed Name l! Signal e t Month Day Year Z fT 11 o b ironsporter 1 Acknowled ement of Receipt of Materials W p Printed/Typed NomeeZ-1 / Signature MgDth Day Year/ W P _- LL- 018. Trans rter 2 Acknowledgement of Receit.of Materials 0 R Printed/Typed Name Signature Month Day Year T LU E v� R (aj 19. Discrepancy Indication Space F Z A C 1 L 1 20. FociOwner r Operator Certification of receipt of hazardous materials covered b anifest exc t as noted' item 19. T Printed/ ed N eJ Sign re t ay ! e r tll ;� J it DO NOT WRITE BELOW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. LDTSC 8022A(1/99) (Generators who submit hazardous waste for transport out-of-state, PA 87022A produce completed copy of this copy and send to DTSC within 30 days.)