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State of California—Environmental Protection Agency <br /> form Approved OMB No.2050-0039{Expires 9-30-991 See Instructions on back of lee 6. Department of Toxic Substances Conh <br /> Please print or type. Form designed for use on elite f;2 pitch) far: Sacramento,California <br /> UNIFORM HAZARDOUSTCIA <br /> . 'G'enerator's US EPA ID No_ Manifest Document No. 2. Page l Informafion in the shaded areas <br /> is not required by Federal low. <br /> WASTE MANIFEST 1 0 . 0 O 12 3 5 0 0 fl 0 1 of 1 <br /> 3. Generator's Name and Mailing Address <br /> B + R AIJTfl REPAIR <br /> 6789 MAIN ST. <br /> o SAN JOSE CA 95128 <br /> Ln d. Generator's Phone f s <br /> !� <br /> CV 5. Transporter I Company Name 6. US EPA ID Number <br /> Ln <br /> CP <br /> Coldun Bear TransportationlqAlDlll7l8ll3l2ll6l5 <br /> oO 7. Transporter 2 Company Name 8_ US EPA ID Number <br /> r <br /> a <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> Kalifornia Environmental <br /> > p 111213 Septic Tank Wy <br /> } <br /> Oakland , CA <br /> ` 12. Can 13. Tota! 14. Unit <br /> I lay 71. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No Tye Quantity Wt/Vol. <br /> ) T a. Oily Absorbent , Non-RCRA Hazardous <br /> ' 3 G Waste , Solid 1 12 11 1 1h <br /> � a j b <br /> coE <br /> A <br /> a T <br /> m O <br /> R <br /> w d.. <br /> I-- <br /> Z <br /> w <br /> LJ ' <br /> rs <br /> V) <br /> L <br /> ac <br /> W <br /> d <br /> 15. Special Handling Instructions and Additional Information <br /> 0 <br /> H <br /> Q <br /> Z <br /> to <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,pocked, <br /> marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and nationul government regulations. <br /> IF I am o large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to ebe degree I have determined to be economically <br /> a practicable and Ifsai I I ave 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 /> Q available to me and that I con afford. <br /> y Printed/T ped Name Signature ti Month Day Year <br /> Z �Bt No NES a z r © 4 <br /> U+ � 17. Trans otter 1 Acknowledgement of Receipt of Materials _ <br /> E Printed/T ped Name Signatur Month Day Year <br /> :E P Flu t> 101 <br /> .Z i +� <br /> LA- 0 18. Trans orter 2 AcknowlA mento Recei f of Materials <br /> O i Prinfed/Typed Name Sign Lure Month Day Year <br /> W, F <br /> Q' <br /> V F 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> M20FOwnerorOeraior Certification of recei t ofhazardous materials covered b this manifest exce t as noted in Item 19.ed Name Signatare Month Day Year <br /> G1 ( c7 O <br /> DO NOT WRITE BELOW HIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> 22A ld/97) (Generators who submit hazardous waste for transport out-of-state, <br /> DTSC 80 <br /> EPA B7022A produce completed copy of this copy and send to DTSC within 30 days.) <br />