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%N of Califosaw--frarkmnmmbl Protection Agem y <br /> xm Approved OMB No.2050-00391Fxpires 9.30-991 See Instructions on back of I 195 Ikpvrtmanl d Toaic$ubab«es Contra <br /> mu prml a lype. Form designed for ase m dW 112-pikhf <br /> Sacramenb,California <br /> UNIFORM HAZARDOUS 1. Gerwralos's US EPA ID Na- Manful Docwnem No. 2. Pogo 1 In�o.6.in Ilse shaded ams <br /> CAT 0 8 0 0 1 9 2 9 2 8 2 1 1 8 1 is net required 6,Federal law. <br /> WASTE MANIFEST of <br /> 3 141 t.,Address A. -Qiss Nwnifest 1`'o<dment F(mi(!eT - - <br /> t� <br /> P.O. BOX 5095, RW-Met,0 Roo P, tt3Foo� 2409-5583 <br /> PAN 1----- CA 94583 (�f rBt� - 8g(�(� a Stan,Geaeralar:IDID <br /> A Gonorator'z Phone <br /> n �¢, 6. US EPA ID Number C Btua Transporters N[Rosch 748 <br /> IUMED=011, INC. CAD 0 6 3 5 4 7 9 9 6 Iran sPa es Via (908f2681194; " <br /> 7- TromgxeM 2 Cmnparry Nome S. US EPA ID Number E Stale Tmaspo w m[Rourved.) - <br /> Trraswmter� pboon - <br /> >�Dei g F«if y me ad Ste Add., 10. US EPA ID Numbm j Stake F«ibty's ID- - <br /> �c F]tv� t =nl Technologies <br /> 2081 Hay Road H: Tacihtys More - <br /> o Fast Palo Alto, CA 94303 1CAD 0 0 9 4 5 2 6 5 7 (415) 3j38 <br /> I I. US DOT Descd hon - Win Pr Shi Name,Hazard Class,vad ID Nscmber 12. Contomo,s 13. Total U. Unit <br /> P Imc 9 ^Por PP'^9 ) No. T G..Kty M/Wol E Waste Number <br /> DASTE TLALB LIQUIDS, I.C.S.(GM111B, DI09L), 3 811993 PGII s <br /> MU213 <br /> O RO (11018) IRGI(128) viol / T T G EPa/ar«11001 <br /> 6. State <br /> m E EPA/Odmr <br /> R <br /> A <br /> s T <br /> m O <br /> R EpA/Other <br /> d. _ Salo <br /> 2 _ <br /> W <br /> U EPA/Other <br /> Abo,,s <br /> Sys FAL, I_ I <br /> 15. Special Handling lnsnvctions and Additional lnF«motion L ITi� i1q�! E�pJl�j� STs <br /> IIBIMY MKISB CALL (800) 947-7701 l /� <br /> *e /� _T G; <br /> 16. GENERATOR'S CERTIFICATION: I hueby declare That Its,c«tents d this coa+ignme si me Fully and ecru descr's6ed.6o.by proper a6ippirg mens and are cbssiRedck <br /> ,paed, <br /> C mated,and libeled,and-are in aB respech in proper condition For transport by highway a«ording toapplicabfe i^ternalional and natio�wl gwnnment regulations. <br /> If I an a target quantity r,esger omr,1 certify that 1 have a m in pl«e b reduce the wIume and to.kiy of waste generated ro the degree I hero determined a be«ommica11Y <br /> ti and Ilsvenr and shot I have elected 16e prac6co61e generator, <br /> ma,s a goo«disposal currently i my <br /> vatsi men rich minimizes Ilia presets acid bro n thrmt t human health <br /> and the environment;OR,ifsl om o small gmntiy gmmata,1 have made a good bids effort to minimize my wire generation and colts the best wast¢management method that is <br /> « avmI.66 to me ad dent 1 con afford- <br /> P- md/Typd Name to sigmture - M«th Day Year <br /> Z , N F ' A a o ia <br /> T77 Trans 1 Ah .wed d R«ei d Materials - <br /> jPrinted/Typed Nanse S' re n month Dal' Year <br /> iE✓ RTS 2 23 vZ <br /> u. i 18. Troarspairler 2 Acknowledgement of Receipt of Materials <br /> co T <br /> Printed/Typed Nome Signatem, Mend, Day Year <br /> E <br /> rem <br /> R <br /> 19. Diurepancy Indicative Spore <br /> Z F <br /> — A <br /> C <br /> 1 <br /> L <br /> t 20. F.'I*ft Owrser or Ottersasor Ceeli(icotion of memip,of hazardous matmida cavared Ly this manifest ea< I as noted in Nem 19- <br /> T Printed/Typd Nome Monde Dal Year <br /> ►m DO NOT WRITE BELOW THIS LINE. <br /> White- TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS- <br /> !SC 8022A 11/991 To. P.O. Boz 3000, Sacramento, CA 95812 <br /> yA 8700-22 <br />