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Shale al Califamio—EnvironmeMol Protection Agency <br /> ares Approved OMB No.2i5P003PIEzpires 9-30-99) See Instructions on back of Te 6. Department of Toxic Substances Corsln <br /> Tema print«type_ Form designedfor usem efif(12-pikh) wr. _s. s«ramenic,California <br /> 1. Geoge for i US EPA R)No. Manifest Documanl No. 2. Page 1 Information in to shaded arms <br /> UNIFORM HAZARDOUS is not required by Federal lour <br /> WASTE MANIFEST1Cjkj 1411 I S 5 I of <br /> 3. Generoro/s Name and Mailing Address K- Stato Mani <br /> Iles Paciflc Bell 213 9 5 <br /> P.O_ Box 5095: Room 3E000 San Raman re 4dFR-1B. Sloss Gnae:ahrs to <br /> i A. Geeeratar, Phu e 1 Bio lyir-irir .f b �! <br /> 4V - 5. Transporter 1 Company Name 6. US EPA ID Numbc, C. stole Transporters i)j f <br /> w <br /> mEC010W control r>w:trIes F IAI q 9181210131 U 1117 3 D Transporter',Phew <br /> y 7_ Tromp«Ir 2 Campax,Wme 8- VS EPA ID Number E Stall TransporFeli tl lg.serpd) r* <br /> ,� i F.,'Isnnsparifr Phone <br /> n 2 9. Designated Focilitydiorne and Site Address 10. US EPA ID Number <br /> i Pec;;Iw cr.�:f=l Cw.....to 9 K s 6 s <br /> atri S <br /> _ ay RoadM. <br /> e.yt3« ty�R ;;;• ,� — ' <br /> Q East Pan P&O CA 94303 PA - 0 Q 4 51650-324463 <br /> 1 , <br /> I 71. US DDesceWon linclu li.9 Proper Shipping Name,Ilozord Class,and ID N.mbml 12. Cantoinars 13. To" It. U t <br /> OT <br /> No. T Oumetity -VAIVol <br /> ru <br /> 1IllE '�DOQI o0 <br /> A grac <br /> Lt T <br /> m O <br /> R <br /> d <br /> -T Nis <br /> v <br /> W <br /> ':...1. _ jet 3•-£kt" ^f +>t" <br /> 15. Special Handling hatraco ms and Additional 1.6.6. <br /> Z . - ♦tcae pfoper FzrOtec'-Ye equiaieienk Wfli1I <br /> ile a11sJlh-19- Veitl <br /> yw Or vOl'ui-les are approx:fniakc_ ^A <br /> Hour emergency telephone number 1-116-977-7777 (Pacific Bell) ERG# 128 <br /> ECI.1/=PISz7a elkl'; site address- '} O /z Os U A 9w e <br /> Q Ib. GENERATOR'S QITIR10N <br /> CA7 : 1 hereby declare shot des content'of dais c g nt filly a d accvralely described abo.e by proper shi�irg name and are classified,pocked,, <br /> V marked,and Mbeki,and ons in.R respects in proper condition For yanspon by hi9hu.y according to app amble international and nation. govemmeat r.guhticns- <br /> If I am a Mrge quonfiy gene.amr,I certify that I hone a program in ploce se reduce the vM me and toxicity of waste generated to the degree I hoe determined to be ac«wmically <br /> w pocticoble and that I hone selected the pr«timble method of ymrment,$we",«disposal currently available to me which minimizes tree <br /> and future threat in human hmlt6 <br /> and 1M emkmmeet;OR,if 1 am o—0 quantity aerm-Irs,I ha.o made a g.ad faith effort Io minimize my haste genoration and select the fust-muss monagemans method tus is <br /> O available to mead shot 1 cm affo.d. % <br /> Pd /Typed Nerej Si Month Day Y <br /> er - �� I 1 '8 a <br /> 0 P 17- Tran rher 1 Acknowledgement of Rech of Matariu(s <br /> ac R <br /> us ; Prinkd/TypeNama - &phetwe. . - Mmdh Day Y <br /> ` <br /> Challe, <br /> 18 <br /> 1 <br /> .I I8. ran 2 tal � alMrsMids <br /> W T PrinPod/Typ d Nome Signalun, - v month Day Year <br /> n I <br /> 19. Discrepancy IndmMion Space <br /> IF <br /> A <br /> C <br /> 1 <br /> t <br /> 20. Facility Owns or gewhor Corti&axon of receipt of hazardous materials covered by this mmilest exc as noted in Item 19. <br /> T Pri.W/T Signature - Month Ye« <br /> Iles <br /> DO NOT WRITE BELOW THIS LINE. <br /> -SC 8022A(1/991 White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS- <br /> 'A 8700-22 - To: P.O. Box 3000, Sacramento, CA 95812 <br /> r <br />