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.pale of Califoinio—Environmental Protection Agency <br /> .em Approved OMS No.2050--0039 IF*.,9-30-991 See Instructions on back of pry 6. Department of Toxic Substances Control <br /> ease print e,type- Form designed for use an elite(12-pitch)yp r. .00- 195 Sacramento,California <br /> r _ _ _ _. __ <br /> m <br /> s " 1. Generatofs US EPA ID No. Manifest Document No. 2. Page I In(orvfian in the shaded areas <br /> UNIFORM HAZARDOUS is not mgsirod by Federal low. <br /> WASTE MANIFEST CAT 0 8 0 0 2 1 9 4 2 8 12 .10 9 6 or 1 <br /> 3. Ger'.atoh Name and Mailing Address Nie eS n fest Docum tN b r"" -5 ref_ <br /> %exPA=C MsT 220955 ' <br /> PO IM 5095 R" #3ID00 <br /> a. Generator's Phone SM PA14M CA 94583 — bb S <br /> ��e�s �h518z VSs � 1 � 1� f ' <br /> 'Litt"t�PATION & d. US EPA ID Number Q ` (er's:10 RW*748 <br /> h iC <br /> m sq <br /> RF2¢DIATION, INC. ICIAIDIO1613151417191916 s s .' lei 408)268 .1.196 <br /> 7. Tanspormr 2 Company Name 8. US EPA ID Number - <br /> T_;,' <br /> Q ( ) <br /> 9. Designated Facility Name and Sift Address ar, 10. US EPA ID Number <N <br /> Go'ag <br /> SEE At7 F/�erury _ 1 _ _1 1�_ <br /> 21981: Bay Ro&d— <br /> fox S <br /> a <br /> 1 I. US DOT Description ludic Proper Shipping Name,Hazard Class,ord 0 Number) 12. Containers •13. Total t IA. Unit <br /> P lint s 9 raP PP nB 1 No. T Oluantity Wt/Vd - <br /> Z <br /> r a IASTR runkaLI LIQUIDS, 1.0.3.(GMLIRB, DIESEL), 3 811913 PGII <br /> G RQ (8018( 8RG9(128) Viol I T I T 01 jj 11018 G <br /> E b. <br /> N <br /> n E <br /> R _ <br /> _A - <br /> - t C, <br /> Y rt <br /> Sp O <br /> R <br /> d c <br /> 15. Special Handling Instructions and Additional Information <br /> Q MGSRCI USPOISE CALL (800) 947-7101 <br /> 5R^I �1abFi� <br /> 16. GENEgATOR'S CERTIFICATION: 1 hereby declare that the osnionts of this consignment arc fully and acwsaW described above bbyy proper shipping name and are clasziRed,pocked, <br /> marked,and Inhaled,and are in all respects in proper condition for Imnspod by highway acceding toapplicable internoticm tend rational government m9.Iotion£. <br /> If I am a large quantity gmaratar,I cartily that I have a In am in place ro red.the volume and toxicity of waste generated to the degree I have determined to 6e emnomlcal�lY <br /> '- pracrioable and that 1 have elected the practicable method of ken tment,storage,or disposal currently available to me which minimizes the present and future threat to human heaNh <br /> a amt Bra a tment,OR,if I om a..If quanky generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> awilabla a me and that I can afford. - <br /> Prinbd/TypedName Sig Me Month Day Year <br /> Z N4v t LL-t"S Z Z <br /> N ; 17. Transpoeux 1 Acknowled ement of Recei of Materials <br /> Printed/Typad Na a Signals'. Month Day Year <br /> seeRo6 �k� �t ��� Z 17 o z <br /> R 18. Tan 2 Acknow c1 ement of Receipt of Materials <br /> 1 j Printad/Typed Name Signature Month Day Year <br /> E <br /> t <br /> eeses 19. Discrepancy Indication Spam i •-6a.11A.lP�r -�4e.\id.t Ct-�u-yQd�ar <br /> ®/ �;Itny+ov, t,Tdrr�llz'Fssaki4 <br /> ii7'tCi°-i'Cl 1 11\eai� 'T n.E.o tk J)HLCIo <br /> see 1 20. F i Ownr or to CertiRaallpr of recei t of haza.dws maftrials coveredby1hi.manifazeeptuanomeliniftem 19. <br /> T P' - rtyped No. Signaht / Month Day Year <br /> Y d <br /> m <br /> �r DO NOT WRITE BELOWS LIN 1?, 1- U <br /> SC 8072A IT/99) White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS_ <br /> `A 8700--22 10 <br /> To: P.O. Box 30, Sacramento,acraento, CA 95812 <br />