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$hila of California—Environmental Protection Agency <br /> as Approved OM8 No.2050-0039(Expires 9-30-991 See Instructions on back of pr -&195 Department of Toxic Substances Control <br /> ]!'ptfiil or type:'-,,,.de'sigmsd far use ort elite(12-pikh) - Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generale'.US EPA ID No. Manifest Document No- 2- Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST C1 AT018101012111,315151 8 12 0 9 9 of 1 <br /> 3 PACIFIC FMMali.,Address li es x er O <br /> PO EIM 5095, ROM #38000 J <br /> A. Generators Phan, WWON CA 94583 (925)823- 84'b6 � <br /> F"HA9ae1W3PMTATI0N & 6. US EPA ID Number _ R m w <br /> RBMMIATION, INC- ICIAID10161 <br /> M1'•z±S <br /> 7. Transporter 2 Company Nome 8. US EPA ID Number <br /> l <br /> 9. Designated FxiMy Name and Site Address bf 10. US EPA ID Numbw <br /> 3 <br /> i (3ox S a*fir <br /> > r <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Oars,and ID Nwnber) 12. Contoiners 13. Total 14. Unite <br /> No. -T Ouantiry -Wt/Vol .._T <br /> _I a. USTI FLA LE LIQUIDS, 1.0.S.(GASOLIM, DI1SKL), 3 URI 993 KII <br /> O RQ (0018) 116#(1281 O o T T G <br /> Se N b. <br /> 'I E <br /> R <br /> I!b T — " y <br /> f 0 <br /> iI <br /> R 3` <br /> d <br /> k � <br /> 15. 5pecia1 Handlmg lnsvucnons and Additional lnformatmn • S1Ta APWtf£5S 2-67Z S4%zT- 11 Tt1 5 t <br /> HIDDIMCT 19SPORSB CALL (8001 947-7701 KAT -V f c-A <br /> 16. GENERATOR'S CERTIFICATION: the declare that the contents of ibis consignment are fully and accurately described above by proper shipping none and are classified,packed, <br /> marked,end labeled,and are in all respecb in proper condition for transport y highway according to applicable international and national government regulations. <br /> If I am o large quantity generaror,I certiy that I have a proaggrnm in place to reduce the volume and toxicity of waste generated ro the degree I have determined to be economically <br /> proctwbin and shot I have selected the�racticoble method a fteatment,storage,or disposal currently available tome which minimizes the present and future threat to human heal <br /> and the environment;OR,if 1 am a:mall quantity generator,1 have made a good faith effort to minimize my waste generation and:elect the best wash management method that is <br /> available x,me and that I can afford. <br /> Prin Typed Name Sign c Month Day Year <br /> t 7 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> t <br /> APrin T Name Sig Month Day Yeor <br /> R <br /> S <br /> P <br /> R 18. Trwaportw 2 Acknowledgement of Receipt of Materials <br /> b T Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> F <br /> 19. Di=epanry Indication Space j)ar K&A m VirphI( <br /> Da51y1,nalz,� ra[.:1t}.j f'hu <br /> A �orltrkt�,}eYk Eny%renrkwn-h`1 Tee. <br /> W— �� Act, 1701 TZ1Q.xo^`��' <br /> c a+ al' } 22 �frJ3¢ i'fSt6'-� T �✓H6 -2 <br /> 1 20. Facility Owner or Operator Certficaeao of rccai hazardous materiels covered b this manifest ex as noted in them 19 <br /> YPrinted/Typed Name Signature / ' Month Day Y <br /> L DO NOT WRITE BELOW THIS LINE. I-?- Z 3 b'Z <br /> C 022A1/99 <br /> White_ TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> 877 — <br /> 0022 ) ToP.O. Bcx 3000, Sacramento, CA 95812 <br />