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a <br />V <br />Ck <br />C, <br />L <br />Z <br />LL <br />LL <br />tz <br />LL <br />LL <br />LL <br />C; <br />LL <br />v. <br />Q <br />L <br />ved OMB No. 2050-0034lip irei,9.30 <br />,... <br />or type. Form designed for use ori elite <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 0 11 /991 <br />EPA 87700-0-22 Green: TRANSPORTER RETAINS <br />} <br />UNIFORM HAZARDOUS generators US EPA ID Na.Manifest pocume " .agerma to t nTo <br />Z n not recjulr� % federal (aw" <br />WASTE MANIFEST [ (� ' <br />7 °' af° <br />3. Generat Name a oi4q kddre s �j j y / w <br />A State Manifest Document Dumber �/ �� I' <br />n/ <br />B. State Generator's ID <br />\ <br />A. Generator's Phone (< I/ f <br />�o l <br />n5. <br />Transporter I Company Name 6. US EPA ID Number <br />C. State Transporter's ID [Reserved.] <br />1 NC • SC' R 07`15 0D. <br />Transporter's Phone <br />O_ <br />S0Q 669-5840 <br />7. Transporter 2 Company Name , e <br />. State Transporter's ID [Reserved.] 44 <br />J <br />tF. <br />Transporter', Phone <br />9. Designated Facility Name and Site Address 10— US EPA ID Number <br />G. State Facility's ID <br />i <br />050144 <br />C D :9.9 1 <br />_ _ <br />'j TAF ?"/—TeL f' -- 1 l :a��N ,JOSE � I <br />� � <br />1021 3ERRY—E—SSA RD CAD059494310 <br />H. Facility's Phone <br />_ <br />J <br />SA11 JOSE CA 95133 <br />$OO 545-3358 <br />11. US DOT Description (includingProper Shipping Name, Hazard Class, and ID Number) <br />P P PP g <br />12. Containers <br />13. Total <br />14. Unit <br />No. <br />Type <br />' <br />Ouontity <br />Wt/Vol <br />I. Waste Number <br />= <br />a. <br />11 R(; RA HAZARDOUS' WASTE LIQUID <br />State <br />222 <br />01'L. ,ATE R, SLUDGE( NOT DOT REGULATED) <br />TT <br />EPA/Other <br />G <br />E <br />1 / <br />� <br />> N <br />b. <br />State <br />I E <br />R <br />EPA/Other <br />r A <br />t T <br />c <br />State <br />i O <br />EPA/Other <br />R <br />d <br />State <br />1 <br />1 <br />i <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes Listed Above <br />b <br />d. <br />15. Special Handling Instructions and Additional Information <br />MFST R/T4000000000 0--000-00 <br />T1 <br />EI1Ell C.r.4Ci' :Lt.SP d00-468-1760( 24 HR). IF UNDELIVERABLE: RETURN TO ?EIINERATOR, <br />'3IC s'30RP AUTHORIZED TO RETA IN LICENSED SUBSEQUENT CARRIERS AS NECESSARY, <br />w <br />D- <br />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 />marked, and labeled, and are in all respects in for transport by highway to international <br />proper condition according applicable and national government regulations. <br />If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />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 health <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 />available to me and that I can afford. <br />7 <br />Printed/Typed Name /1' <br />Signature �,_ .4 v' % <br />Month Day Year <br />TR <br />17. Transporter 1 Acknowledgement of Receipt of Materials j <br />NPrinted/Typed <br />Name <br />Signature - r� <br />Month Day Year <br />P <br />7_ <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />RPrinted/T <br />T <br />YP ed Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />rv. <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />Y%/ <br />Printed/Typed Name -- '—" <br />Signature / / <br />r- <br />Month Day Year <br />__. <br />/ <br />.7.. <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 0 11 /991 <br />EPA 87700-0-22 Green: TRANSPORTER RETAINS <br />