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;m*of C°li(onnr-Envirmmmld ProlMim Agenq <br /> m Appaoved OMB No.2050-00391Ezpir«9-30-991 See Instructions on back of po-P�195 Depa.tmsm Teaks alifcnraa Contrd <br /> ase print ceype. Fwm designed For use m elite(12-pikb)" Sacramm�b,Califamio <br /> 1. Cr«mrolors US EPA ID No. M°nikss Dac°mens No. 2. P."1 Inform°lion us 8a sboded m. <br /> UINi. <br /> ASTE MANIFESTFORd1 HAZARDOUS CAT 0 8 0 0 2 6 0 7 3 8 2 1 2 3 of l notagairod by Federal law. <br /> YIt <br /> 3 �f �°g Adder . _�:y �y p <br /> 1 P.O. BOX 5095, 181i3WOO B Sae Ge lawnsD — L s 58 <br /> $AN �;sys�srwM CA 94583 �h5 )�,j– <br /> 4- (,eneralor's Phorm r 1 <br /> r 6. US EPA D Number C 5)ate Trmsportele ID(R,,,,,j W48 <br /> m ,MMMIMTONDec. C A D O 6 3 5 4 7 9 9 6 D Tao e s Plw o <br /> _ (408)268-11$6' <br /> 7. TrmVa~2 Coepmry"wee 8. US EPA ID Nva be, E. SkAa Transpwt�'s i0 LR_as ed-1 <br /> .. F Trgnsponers Pham — <br /> Q o Face- Name and to4d�echnologles/ 10. US EPA ID Number Satre Foci s!D <br /> �Etr��noerE�a <br /> F 2081 Bay Road ♦. r� y,vho. <br /> 0 East Palo Alto, CA 94303 CAD 0 0 9 4 5 2 6 5 7 (415) 324-1638 <br /> 12. Container. 13. Total II- Unit <br /> 11. US DOT Desrripfion lindadiN Proper Shipping Name,Hazard Class,and D Humberl No. T 11 Tota Wt/Vol f Waste Numb« <br /> 7 IISiH YL89Sli1 LIQOIDS, 1.03.(GISUM, DI18B,), 3011993 YCII Se 213 <br /> = G RQ 11)0111 EM(128) C, ' T I T 0 ,000 G EPA/04.6 1 <br /> E b SdP <br /> 6 N <br /> a°1)° E EPA/CMher <br /> R <br /> A a slate <br /> T <br /> Ca O EPA/Olhar <br /> R <br /> d. sate <br /> iy EPA/Other <br /> U <br /> ••• - € K. H°ndhng Codes(or Wosms tided Above <br /> 15. 5p«iol Handl g I skucnans and Addifionol InFormo�lon C �n I Aa <br /> L;r <br /> 9UGM 1RSPME C1LL (800) 917-7701 -5 ,—, Fc- ►4 t7p Pt55= <br /> 1-777 �Vl` J <br /> 16. GENERATOR'S CERMICATION: 1 he,eby declare that the comenn of this consig m ala kly and occur.��,dewibd above by props.shipp.ng name and vre classified,packed, <br /> nmrkecl,and 66e6d,and are in a8 respects is proper concliti—for transport q highway accordiN to applicable international and national government regulations. <br /> 61 am a Iwv arnaey ermrolw,I certify that I have a pr in place a reduce the vokane ad mziciy of wade generated ta the degree I have determined m 6e econ icdlY <br /> a practicable ad.that I hove selected the practicable method of tre°anenl,slwage,w diW ..I currendy available to me whirl minimizes the p,..t and future threat to human he°hF <br /> ad rias emimnnwaU OR;if.I°m a sat°N cl.nlity gen«ator,1 have mode a guod faith effort In minimize my waste generwim and select the best waste mmagement method that is <br /> ad awi666 te me vnd Ow I can ad. <br /> 1 <br /> Prin YP°d Nam• signew" wkth Day Y" <br /> LV/' A ` i Z. o r <br /> l� i WL �Yt <br /> T 17, Tranpa~1 Acknowledqee,e ,of Recel a of Maredds <br /> A Printed/Typed Name . Sig^alura MOAd' Day YOOr <br /> s R bc. f �t Y z30 2 <br /> O a 18. Tran 2 AcknowkclM of Recei t of Mat«ivls <br /> R Pruatd/Typed Name Sigmrore Monti Yew <br /> T <br /> ..t E <br /> R <br /> I 19. Drs«epaacy IdsccRae Space " <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> iy. 1 20- facih Owra«w ra Certificotim of rerei of hazardous materiels coved this mvnika t m rated in Item 19. Monalh � Yem <br /> PrinkdrTypd Name AgmNre a <br /> T <br /> DO NOT WRITE BELOW THIS LINE. <br /> albite: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A(1/991 - T. P.O. Box 3000, Svcromenlo, CA 95812 <br /> EPA 8700-22 - <br />