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K LL 4 U t Q N W f" Z W U W 0) Z O a co W ,;.4 -Health and Welfare Agency See Instructions on .QMB No. 2050,--0039 (Expires 9 y runt atype. #orm d6signed.for use on ei -pitch typewriter), and Front Of ®` UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest ASTE MANIFEST Document 3. Generator's Name and Mailing Address Santa Fe Railway Site,, Amtrak, Lincoln Ave. Diaiond and East Worth St., Stockton, CA 95M 4. Generator's Phone ( ) 5. Transporter t Company Name 8. US EPA ID Number Erfckson, Inc.3 9 7. Transporter 2 Company Name S. US EPA ID Number 9. signated Facil ty Na an Site Address 10. US EPA ID Number at I n . Wi a nt F it ity, rst , CA C/O 740 East Carn"Ie• sSanba: i a et4e CA 92409 IC 1AJqjQAjtjM 11. US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) Non KRA ftzar4wsVas Sol ids E N E b. R A T 0 R I c. i J Q U J J CL r/) O } U Z 0 W W Z Q Q W (j) 4 U Z of Page 6 Department of Health Services 7 Toxic Substances Control Division Sacramento, California 2. Page 1 Information in the shaded areas of i is not required by Federal law. ,. _ ;::. i •"*I 5 A 4 ! M 12. Containers 13. Total No. I Tvoe I Quantity 18. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, marked, and labeled, and are In all respects in proper condition for transport by highway according to applicable international and national government regulations. It I am a large quantity generator. I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree i have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the presenj and future threat to human health and the environment; OR, if I am small q generator, I have made a good faith effort to minimize my waste pen ion and select the best waste management that is available to me a that I can afford. Print Y N Sign ` Month Day r 3 ,li,") T AL R a K d. 18. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, marked, and labeled, and are In all respects in proper condition for transport by highway according to applicable international and national government regulations. It I am a large quantity generator. I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree i have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the presenj and future threat to human health and the environment; OR, if I am small q generator, I have made a good faith effort to minimize my waste pen ion and select the best waste management that is available to me a that I can afford. Print Y N Sign ` Month Day r 3 ,li,") T 17. Transporter t Ackn6wiedgimeat of Receipt of Materials R A N Printed/T ped Name Sigrnature ; el Month Day S C a 0 18. Transporter 2 Acknowledgement of Receipt of Materials T Printed/ Typed Name Signature Month Day E 19. Discrepancy Indication Space F A C I L hell./ 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. T Y 1 Printed/Typed Name I Signature Mnnth r)o,. DHS 8022 A Do Not Write Below This Une EPA 8700-22 (Rev. 8.89) Previous odificne are obsolete. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS