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State of Collforni nvironmenlal Protection Agency <br /> Farm/gycoved OJAB No.2050-0039(Epires 9-30.99) � _ See Instructions on back of '%6619595 Deportment of Toxic Substances Conte <br /> �slease print m type. form designed for use on elite(12p '!Jerikld ( ,� Sacramento,California <br /> 'UNIFORM HAZARDOUS O P pL7� O C) Manifest Docomeal Na 2. Page 1 Info mofiam a by <br /> shaded anus <br /> WASTE MANIFEST <br /> a 2 l I Q of 1 is mol required by Federal law. <br /> 3. P u a�:ng Add,, - A. Sro+e Monde,f ibcament Number 22095171MIC. <br /> PO EIM 5095, R" i3L7000 B Sate a w'a ID <br /> < neraa , Pho n r <br /> WM CA 945a3 (125)V3 <br /> )V3 <br /> FH16Me 0H & 6. US EPA ID Number c Smte T,r m po.tars iD(R_� 48 <br /> an <br /> RE2ff•DIATI011111 INC. 1CiAAOi6A5i4j7j91916 D T,.,parts ,Phe^e (408)268-1196 <br /> - —= <br /> ]. ironsporter 2 company Name S. I15 EPA W Numbm E:stoma Traaspi+Ae2s ID tRosuvedl t <br /> —Y—_ <br /> �� ,• F. Trgnsporte.'s Phune r <br /> 'Q 10. US EPA ID Number G: Stores FadMvs ID - <br /> 9 Designated Focil��iryry t�d�o�ma and Site Address <br /> i Rowic IIrviF®toental Technologies Icip q qisd ) <br /> > 2081 gay Road H. F«iuty,Phone <br /> o East Palo Alto, CA 94303 JCJAJD 0 0 9141512161517 (41 ) , 24-1-638 <br /> t 11. US DOT Description tincludirg Proper Shipping Nmne,Hamid Class,and ID Numbed 12. Contui I 13. Tobi I}. Unit <br /> ,J L2. T 13. Total <br /> W. VcJUnit <br /> t Waste-N he <br /> Sm <br /> UM PL1101111 LIQOIDS, L0.5.(6 LI11, DIOW, 3 011993 PCH 213 <br /> G RQ (1011) 9191(121) 0101 T T G EPA/Other D001 <br /> 001 <br /> E b smote <br /> o N <br /> m E EPA/aha <br /> v R <br /> � T <br /> m O EPA/Oihs, <br /> R <br /> --d _— 0 state <br /> w EPA/Otter <br /> V <br /> far; r s. zy i t I t "P.odes.fa,Wastes Listed Above <br /> . <br /> Y yE <br /> e : + <br /> 15 Special Ha dreg Insmuctions grid Additional Informal;on <br /> a B11Q60CT I0POAS6 CULL (100) 917-7701Ad es. <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare dsar the content d Itis<vnsig ret are fully and..nt�y described above by proper shippng name omcl are dassrfred,pocked, <br /> < marked,and labeled,and ore in all respects in proper,condition lar transport by highway according to opplicable international and rwtiond government regu6Fone. <br /> J <br /> If Ian a large quantity gerrralor,I certify that 1 have o program in place to reduce the volume and toxicity of waste generated m the degree I Isom determined to Ine economically <br /> 1 practicable arid that I bore selected the practicoble method o treatment,storage,or disposal ca reotly a,arlable to me which minimizes the present and future threat to human health <br /> and the environment;OR,if I om a snail foantit,generates,I.have made a good(aids effort ea minimize my waste generofc,and.elect the best w ste management method that is <br /> available to me and that I cors Acord. <br /> 00 OE Prim /Typed Name Sig Month Day Year <br /> S Z Z <br /> W T 17. r 1 Acknowl of R,,ipt of Molerids - <br /> 1' 1 Printed/Typed - Signature Month Day <br /> ,�L , r 2. 1-10 e i <br /> o- - @ 18. Tran 2 Acte t of Recd of Moteriuls' - <br /> TPrinted/Typed Name Signature - Month Day Year <br /> -u E <br /> a g <br /> 4J 19. Discrepancy Indication Space - <br /> Z F <br /> A <br /> _ C <br /> 1 <br /> L <br /> Ime ( 20. F«' Owner« CertiBeation of oFharardovs materials covered th;s manifest enc as-orad;n gem 19. <br /> T PrintscllTyped Na�ar � - Signature Month Day Year <br /> If „r 0�... s” �- ' 2 3 o v <br /> r DO NOT WRITE BELOW THIS UNE. <br /> White: TSOF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DISC 8022A(1/99) - - - To: P.O. Box 3000, Sacramento, CA 95812 <br /> TEPA 8700-22 - <br />