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tote of CaliFomiq--�Emrironmental Protection Agency <br /> Worm Approved Or48 Na.2050fi039 lExp,res 9-3+D-491 See Instructions on back of 195 Department of Toxic Subslances Contrr, <br /> lease print or type, form dasigned for use on efita(12-pitch) er. <br /> Sacramento,California <br /> UNIFORM HAZARDOUS OAJ77AOp V O Manifest Document No. 2, Page 1 Information in the shaded areas <br /> is not law. <br /> WASTE MANIFEST 8 2 1 © 4 of 1 required by Federal <br /> 3. GeneraNrs Nome and Mailing Address Il Stafa Mariffest[)otumenl Number <br /> Pict 2 �955fi <br /> PO 1= 5095, MM <br /> # f4- Stain C>eineraior`s R) <br /> d- Generators Phone _7__-_" CA 93 �7`)py Z3— �Pp A4 -1 1 1 I 3 I -ILL. <br /> NNumber�' 6. US EPA ID Number C. State Transporters 10(Reser jT $i <br /> 11 <br /> GO <br /> D Trans er s P"" <br /> ? REl��ATI , ]3iC. C A D O 6 5 4 T 9 9 6 t <br /> �o O[38)2fi$-1195 <br /> _ 7, Transporter 2 Company Name S. US EPA ID Number :'State Traosporlorrs ID(Ites--,,d.I - <br /> ' F. Trcrasporte's Phan.f�-~`- - —�'•' <br /> 9, Designated Foci]- FBF. and Site Address 10. US EPA ID Number G State'F...Ii s jr-: <br /> Punic Hf1v�tal Technologies ? c( 6 <br /> 2+061 IISQaa Phone <br /> oc }I, Faciliiy�s Plrona <br /> East Pala Alto, G 94303C A 13 O O 9 4 5 2 6 5 7 X415.):1 --1638 <br /> l 1 <br /> t <br /> Containers 13 Toa4 U <br /> 1 1. U$DOT Desorption(including Proper Stripping Name,Hazard Class,and ID Number) 12. nit .- <br /> WEE. <br /> No. Type Quantity WI/V.1 ,Y..Wastp,.F`Jumbei- <br /> z a UM nM8L LIQUIDS, 1.0.3.(U30LIM, DIESEL), 3 01993 ?GII <br /> "213 <br /> G ItQ (0011) IM(121) 001 T T GE 36 <br /> ErA r , `I00p1 <br /> © N b sroFe. <br /> m E <br /> R rPAIQlfser` <br /> A <br /> o T c. . <br /> m O <br /> R EPAJQtr <br /> d- F St 4t, <br /> Z <br /> W <br /> U EPA/Often '✓ <br /> r. �._ :a3a } ,-s"x 3- trsdfiri �`For'Wasfes tided AbQwe <br /> ri' _} dpi. <br /> W a'?lx} 3'1'tt- W , <br /> Q 15. Special Handling Instructions and Additional Information <br /> '- =MY 1 POSSE CALL (800) 947-7701 <br /> WW <br /> 4 a. <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ore Fully and accurately described above by proper shipping name and are classified,packed, <br /> marked,and labeled,and ore in all respects in proper condition For transport by highway according to applicable international and national government re9ulafions- <br /> _ If 1 am a large quantity generator,I certify that I have a p ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economical) <br /> a practicable and that I hove selected the rocticable mNl csd of heahnent,star or di )Curren y <br /> rn p age, spa Ify avoiloble to me which minimizes the present and future threat to human health <br /> and the environment;OR,iF I am a small quantity generator,I.hove mode a good faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> Prin /Typed Name Signa Month Day Year <br /> Z 1 � <br /> T 17- transrter 1 Acknowl t of Receipt of Materials <br /> R Printed/Typed ame _ �� � Signature Ahun L � � Year <br /> R �Cr <br /> si0 18. Trans ,tar 2 Acknowledgement of Receiptof Materials <br /> o T Printed/Typed Name Signature - Month Day Year - <br /> E <br /> R <br /> 19. Discrepancy indication Space <br /> Z { <br /> A <br /> C <br /> t <br /> i <br /> F 20. Facility Owner or O rota,Certification of receipt of hazardous moterials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> ' C Z <br /> -71 <br /> DO NOT WRITE BELOW THIS LINE. <br /> TSC 8022A II/491 While. T5DF SENDS THIS COPY TO DT5C WITHIN 30 DAYS <br /> PA 8700-22 To P.O. Box 3000, 5acramento, CA 95812 <br />