Laserfiche WebLink
cyte of CaliFomio-Emironmenlal Probclion — <br /> ran Approved OMs No.2050-0039 Expires,9930-991 See Instructions on back of6. Department of razi<Substances C."_sate prim«type. Form designed Tor.Sean el;b llz-p;t6l yp'�y,. f�606195 <br /> S«ramen,a,California <br /> UNWORM HAZARDOUS I' r s US EPA ID No. Manifest Document No. 2- Page 1 1. ma6an in the shaded areas <br /> WASTE MANIFEST C A 9 8 1 4 0 6 9 0 3 8 2 1 U 0 of 1 is not required by Federal low. <br /> -��-1�_)��1 <br /> 3- Generators Name and Mailing Address a St4M � �@�. . <br /> PACIFIC ». 2220197 <br /> 230 �p 018AC�1 ��e Roo y �3E o0 0 <br /> A Generator',Phone PAPA 1 CA 94558 (9aS )8-43 - Of lob <br /> �� e1T •�P11R�TIOlf & 6. US EPA ID Number C. $ttite Transpartafs ID(Re_see 748 <br /> FMONATIONP 11C• CAD 0 6 3 5 4 7 9 9 6 ° Trrn,pa.ter,Ph. (408)26$_1196 <br /> 7. Tramp«tar 2 Company Name s. US EPA ID Number E. State T'�gyporkrsIID[Re.served.I <br /> (I r t Trap .- <br /> 9 Designaled Facility N ane and Site Addr. 10. US EPA ID Number _ - <br /> G Stbe, 's ID <br /> Iaic FS1virtal Techrwlogies <br /> 2081 Bay Road n. FA ! <br /> East Palo Alto, CA 94303C !► ° 0 0 9 4 5 2 6 5 7 (4"1 824-1638 <br /> I I US DOT Description me,(including Proper Shipping NoHazard Class,and ID Numbed 12 cm hers 13. Tolol 1 d.'Unn _ <br /> No. Type Quantity WI/Vol I Waste Number <br /> a GUSTO FLAI9 M LIQOLBS, 1.0.5.(OIISOLI00, 11I911n), 3 001993 DSII sero 213 <br /> D 12Q 10018) 17164 1 1 2 8) O I T T 5 G DOpl <br /> Eb _ __—_— <br /> IN <br /> E <br /> R ERA/cher <br /> T 6� <br /> O <br /> R <br /> -d <br /> E6AIaM, -. <br /> 'tib# "a UM - Bllm a asr; t <br /> IS Sp W Handling Imnuctbns and AddiKon.I I.F...tion <br /> 1111MIXT 113PUSI CULL (800) 947-7701 7E Aaam F-" 333 Ec cllryr va ORFIo <br /> /�. C'ov,er <br /> i ' # 1�'T_! AIAPA, C'AGtF04cJ/A <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contend dais conal =am Fully and accum described above <br /> moped,and labeled,and«e in all ra g by proper shiT9,an rwme artd ora tiossi. pocked; <br /> specs in proper condition for honsp«r 6y highway according m applicable international and natiand government regulations. <br /> see U I urn large..anti y generator,I certify that I have a p 9 m in place to reduce else volume and toxicity of waste genmarod to the degree 1 have determined to be ac,...icallY <br /> p h,A6 and that I hone elected the practicable Method of treatment storage- disposal sun ustly orailobb to me which minimizes the pr sent and future threat a human health <br /> and then.ronme ,OR,if I am a small quantity ger ,somor,1 have made-a goad laeh eRort,o minimize my waste generation and select the best-arm ma tot method rho,is <br /> available I-me and the,1 can afford- nagem <br /> Printed/Typed Name OA) E?/ALF of Signator <br /> Month Day Year <br /> VAN ' F "— / a <br /> � 17. Trona 1 Acknowl en,01 Recei t of Materials <br /> I r.mad/T>Txd Nome Si m - — to <br /> R ►7 2 3 012 <br /> E k RTS <br /> V <br /> Day Y <br /> s' Is. Trvn 2 Adnow - 1 d Receiptof Marorials - — <br /> T Prinied/Typed Name <br /> 1 Signature �* <br /> I Day Year <br /> 19. Discrepancy Irsdi<atton Space _ - - <br /> A <br /> C <br /> 9 20. Fccaliw Owns « Ce if a on o!re e t of hazawau,,rnateriali co erect W this moni6st tuscept as noted in Rem 19. <br /> Y hinted/Typed SignaNre * <br /> Day Year <br /> 6. <br /> DO NOT WRITE BELOW THIS UNE. <br /> 0022A(I/"I - - Miley TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> `700-22 T. P- Boz 3000, Sacramento, CA 95812 <br />