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I <br /> tate of California—Health and Welfare Agency Department of Health Services <br /> Toxic Substances Control Division <br /> Sacramento,California i <br /> Please print or type. (Fwm designed for use on elite(12-pdch)typewriter) <br /> UNIFORM HAZARDOUS 1.Generator's US EPA ID No. Manifest age normationinthe s a e areas <br /> WASTE MANIFEST f'Q C1 1 6 q 8 0 y Docum;nt No. of issWnot required by Federal <br /> 3. Generator's—Name and Mailing A ress . tat �nif qufnent umber <br /> zycc S/ CORP <br /> 3033 Sco-r-r 61 A1,0. SANTA CLARA, CA, 8505 l B.StateGenerator's <br /> 4. Generator's Phone ( O 8 6 - 2 7.2 O <br /> 5. ranspower I Company Name 6. US EPA I --Number tats Transporter's 10d P 97 34GOO <br /> ClHF-M ICpL 'r R2�1SFF)Z GO, C.A.j).0.D.4 .7.7. 40.6 ransporter s one <br /> G7. Transporter 2 Company-lia—me a. US EPA ID Number 1.9tate Transporter's <br /> ransporter s Phone <br /> 9. Designated Facility Name and Site ress 10. US EPA 10 Number tate Facility's ID <br /> 5oO Tj-{ j-W CALIF-VRN/A CCzlMCA.Z <br /> eb 5 1 91 CE (204D acl ity s Phone _ <br /> 5AAJ TA FE MX/G s CA ICA-Do o.5 .4.88 1) -Z.s <br /> 12.Containers 13. 14. <br /> 11.US DOT Description(Including Proper Shipping Name,Hazard Class, and ID Number Total Unit Waste <br /> G No. T Guantity <br /> E a. COAW65111E lI�ASTE ,C/atai0 <br /> E6pewT G'y/�RlC CLo�Q/per' ETCH <br /> R If 74:�o 0o iT T $� CI 12 5 <br /> A b. <br /> T <br /> 0 <br /> � R <br /> C. <br /> I <br /> d.15. : <br /> S; <br /> Special Handling instructlons aAdditional Information <br /> lrJ.FA,E� G,G4s5,eS f' crl-ov&.s , Avo/al cc,At rX-c7- cu�TH EyE3 SKiM <br /> ee--p Our of Oq TAEWAy3. HARM 1ze L To16.GENERATOR'S CERTIFICATION:I Fi3l, LIJi/d.LifE, <br /> herebydeclare that the contents of this consignment are ully and accurately described r <br /> above by proper shipping name and are classified,packed,marked,and labeled,and are in all re <br /> sped n proper condition for <br /> transport by highway according t applicable international and national governmental rep ation <br /> Data <br /> Printed/TName Signature , Month Day Year r <br /> T 17.Tran er 1 AckfSowledgement of Receipt of Materials Date <br /> R <br /> A Printed/Typed Name Sip re t Month Day Year , <br /> a O <br /> 18.Trarisponenowfiadgement'or Receipt 6T Materials' Date I ' <br /> T Printed/Typed Name Signst r Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> c <br /> I i <br /> L <br /> I <br /> T 20.Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifest except as noted in <br /> hem 19. � <br /> Y <br /> Date <br /> Printed/Typed Name Signature Month Day ear <br /> S 8022 A (7/84) White: TSDF SENDS THIS COPY TO DOHS WITHIN 30 DAYS I I <br /> ' <br /> '.PA 8700-22) TO: P.O. Box 3000, Socromento, CA 95812 M�, <br />