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State of Coh6rnia—Environmental Protection Agenc <br /> Form Approved OMB No.2050-0039(Expires <br /> .30!99110 Slee Instructions on back oT pages b, <br /> 4 Please print or type: Form designed for use on elite(12•pitch)typewriter. De poAment of toxic Substances Control <br /> -- Sacramento,ColJornio <br /> Y ' i t. Garrororor's US EPA ID No. Manifest Document No. 2. Page 1 Inlwmation in the shaded areas <br /> UNIFORM HAZARDOUS <br /> WASTE MANIFEST A D 6 7 4 6 4 2 9 V �—' 1 a! 1 &not required by Federal law. <br /> 3. Generator's Name and Moiliry Address A. State' Me..may Document Number <br /> 11REBS. S IIICORPORATRE 2006525 9 <br /> 0 1629 S. seCRANERTo STREET a. <br /> n LORI, CA 95248-4799 r S. State Generator's ID' <br /> h a. Generatou's Photo( � FLETCNER <br /> ,. 563 333-356@ Contest: I I• i <br /> N 3. Transporter 1 Company Nomro 6. US EPA ID Number <br /> c? C. Stole Tronsportees ID R s ry .) <br /> Oo RUNIC EIVIRONO3TAL TECH. A ,D 8 8 9 4 5 2 6 5 1D. Tronspwfer's Mona ( ) <br /> 7. Transporter 2 Company Noma 8. US EPA ID Number E. Stote TranspatM's IDR rued.) <br /> v'J <br /> Lf)Q F. Tronsportot's Phone <br /> V 9, Designated facility Nome and Site Address <br /> N10. <br /> 10. US EPA ID Number G. State Facility.t0 <br /> In Z ( RONIC ERVIROIOIERTAL TECH G. <br /> f -IA I�t®1 91 4 1 51 21 61 �I <br /> t;I- % ?Os . aAtl Rf+.10 ti. Fociliys P-rtoee 1[�SIt13Z4-15�'�f <br /> `° I EAST PALO ALTO, CA 94383 e u 6 6 9 4 5 2 6 5 <br /> V11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12 Containers 13. To 1 A. Unit <br /> Z a. No. Type Quantity WI/Vol I. Waste Number <br /> = <br /> ;Slale3 EPrf1# E 328567127 ' r ahar 213 <br /> N N I b. A ° j" 11861 <br /> O <br /> Do E State <br /> N R ' r • EPA/011ie. 4 f <br /> A Prfl# E 341372 ERR 129 C7 %7� 1III 199T-Hr . ., 0661 I <br /> ® � c (RESIDUE: LAST COIITAIYED,ACETOAEI j State <br /> GO <br /> _ 512 <br /> R Prfl# E 361247 ERG# 128 / O % EPA/oth.r ; <br /> W d. j <br /> Z State <br /> LU <br /> W <br /> EPA/Other <br /> Z J. Additional Descriptions for Materials Listed Above <br /> Z K. Handling Codes for wastes Listed Above <br /> Line 11a. EPA Codes: DM FM F865 <br /> CL�L f <br /> Y <br /> a <br /> C. d <br /> 0 15. Special Handling Instructions and Additional Information <br /> P HR. icy Rmpnm . <br /> Z <br /> U., <br /> S <br /> r <br /> < 16. GENERATOR'S CERTIFICATION: thereby declare <br /> pope the contents of this camel nment ore fully and accuratelydescribed above by proper ship irsg roma and ao classified.packed. <br /> V marked,orsd labeled,and are in oil respects in proper condition Far transport@ hi h p ; <br /> t <br /> by g'wy according to applicable international and nolionol government regulations r <br /> •J-' If 1 am o large quantity generator,I certify that t hove o progwin in place to reduce the volume and toxicity,of waste generated to the degree I have determined to be oconomicolly i <br /> Drochcabla and that 1 have selected the icoble method of treatment,storage,or disposal currently available to me which minimizes the present asd future throat to human heobh <br /> and the environment•.OR,if I am a small quanliy generator,I have maitre gbi�faith effort to minimize my waste generatan and select the best waste management method that is <br /> available to me and Ili t I con of d. \ _ <br /> O Print Ped Name t �' <br /> V Signoturo .' Month-1 Dlay_-� .YYee'or.J�`1 <br /> uj <br /> R17. irons rte,1 Acknowle ement of Recei t of Materials <br /> a` A Printed T ed No a .. <br /> W p Signatur j Month Day Year I <br /> O0 18. Transporter 2 Acknowledgement of Receipt of Materials .. - - <br /> Printed/Typed Nome <br /> W E Signature <br /> V) Monm Day Year I <br /> Q• P <br /> V F 19. Discrepancy Indication Space <br /> Z ; <br /> A <br /> C <br /> I <br /> L <br /> 120 For Owner or O rarer Certification of recei of haxordars materials covered by this manifest toare,as noted in Item 19 <br /> 7 Printed/Typed Name Signature Month Oa Yeor <br /> y <br /> 1�� las 1�4f:r'Ic _ L> ? I '3r C% <br /> Reference lumber: E 288 DO NOT WRITE BELOW THIS LINE. <br /> 11TSC 8022A(1/991 <br /> IA 8700-22 <br /> I <br />