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Sems,of Califo ia—Eavieonmanbl Protection Agency <br /> -orm Approved OMS No.2050-00391E.pi,.930-99) See Instructions on back of p,qe 6. Department d Ta.ic sub:mnc.s Contra <br /> lease print or type. Form designed for ase on cite 112-pihh)1Y1 606195 So r'.to,Cabfamia <br /> UNffORM HAZARDOUSL moo's US EPA ID No Manifest Document No� 2- Page 1 lnfarmotion in the shaded areas <br /> - is not required by Federal lay.. <br /> WASTE MANIFEST C1 Al Tj 018101012131318151 8 12 11 O 14 01 1 <br /> 3. Generator's Name and Mailing Address A stop Iver-den Document Number <br /> PACIFIC MJ - <br /> U02198 <br /> 0 2515 SOM ORANM AVE. RC"'-1 3 'r ID <br /> A. Gane-t-', Phone EFMW CA 93725 (9ar)8•6_ 8844- _ L I I I I I I E I I I I <br /> tRi11LLCcND �ATI�1 & -•6- US EPA ID Number C Siete Transpmiei s R <br /> m Yf D- TI+aM` i <br /> l�IATI011, INC. ansponme s. CAD 0 6 3 5 4 7 9 9 6 -1.196 <br /> t 7, Treasporter 2 Company Name —� 8. US EPA 10 Number ID f R , <br /> J F. Tr6nspLrtell Phooe t ) — <br /> Uas <br /> 9. Designated FucAIX Meme and Site Address 10. US EPA ID Number G, Si.se Facshy's b: j- <br /> FAWc Emirofental Techmlogies _ <br /> `a 2081 Bay Awad <br /> 8 East Palo Alto CA 94303 ICIAID101019141512161517 <br /> 12 Ca 'rmn 13. Total 11 Unit <br /> f <br /> 11. US DOT Desmiphim(including Proper Shipping Name,Hazard Class,and ID Numbm) No. Type Quantity WI/vol Nyn6er <br /> a UM ILLWA6 LIQIIDB, I.O.S.IfdMM, DIEM), 3 M993 [OII Q, I <br /> G (DOII) IlGthlQ Dao T T O O G D662 <br /> E <br /> e N b. <br /> Its F <br /> < R ;kn' <br /> A <br /> T ` <br /> O <br /> R + c <br /> d 7 <br /> W l <br /> shed ,. - K- Handling Codes her Wastes lasfEds <br /> a. 6: <br /> Y <br /> F n <br /> `j <br /> Ir'=1 HQiing Instrvdionr and Addnioaal Inknmalion sSS.S E4 S E a T. <br /> 1rc ADDR E3S T OL I✓ <br /> MMOQ IIIf? M CALL (800) 947-7701 FTEs..Lo , OA <br /> t <br /> =1 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by prop«shipping rams and are classified,pocked, <br /> moral,and lalsced,and ars in all respects in proper condition far transportby high-try«cordin to appbca6le international and nmioral government regulafions. <br /> 1 If I am a large quontiry genmaW,1 certify that I have a pragnom in place to redo.the vdume and aaicity of waste generated to the degree I have determined to be economically <br /> pracfica6le and Ihat I lave sal«ted the proctica6le metlad of traotment,storage,or disposal wnendy available to me which minimizes the present and Future threat to human health <br /> a�rise.rwironment;OR,if I am a small quanfity generator,t have made o goad faith effort to minimize my waste generation and select the best worse management method that is <br /> f7 avae661e w am and that I con afford. <br /> PrinW/Typed Name <br /> Wi JaS EPH JE.] Q/GK o ' Day Year <br /> WBDLsig'"°' <br /> of AogEQ Pt0 70 <br /> Z <br /> .d <br /> CJ T 17. Transporter 1 AcInowledsoment qF Receipt of Materials - <br /> I Printed/Typed.N. Signolwe Monde Day Year <br /> i _ t C. <br /> OI 1 S. Trre 2 Acknowledgement of Recei al Materials <br /> TMweed/Typed Name Signature Month Day Year <br /> wE <br /> If <br /> R <br /> 1 E 19. Discrepancy Indication Space - - <br /> _ A <br /> C <br /> 1 <br /> L <br /> ` 1 1 20. facility-Owner or aAor Certification of r«ai al hazardous materials covered 6,Ibis retailers.. as rated in Item 19. <br /> T Printed/Typed � - signature lAanth Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> )TSC 8022A (1/99) White: iSOF SENDS THIS COPY TO DTSC WITHIN 30 DAYS_ <br /> PA 8]00-22 <br /> - I. P O. Boa 3000, Sacramento, CA 95812 <br /> - <br />