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State Of California-4isalth d fare Agency b See Instructions on Back of 046 6 rt t of Health ices <br />Form Approved OMB No. (Expires 9.30.91) �j"'' i Tib Control Division <br />stances <br />Please print or type. F da ned rasa on 2 pitch typewrdter). and Front of PR 07 c Ssoramento, California <br />' <br />IFOR R®®us Generator's US EPA ID No. Manifest 2. PageInformat' the shaded areae <br />S ANiFEST o u nt No. of is not reltu' by Federal law. <br />S IdlyF <br />3. Generator' a and Mailing Address A. State Manifest <br />Santa ailAmtrak, Lincoln ve <br />Diamond and East Worth Stas Stockton, CA 95206 s. Staits Geneirators ID x <br />4. Generator's Phone ( ) <br />S. Transporter 1 Company Name * 8. US EPA ID Number C. Stat® T er's lt! <br />cvto <br />Erickson._IC A ID 10 2141616131212 D- T e:Phon"o lei <br />13M <br />7. Transporter 2 Company Name 8. US EPA ID Number E. TmAsp~9 ID <br />ds <br />F. T s Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number t#. Side Facility's to <br />r <br />J <br />Fort Irwin Rd. Treatment it iter, rStow, CA F; Z 1a <br />U <br />C/O 740 East Carnegie Dr., San Berdino, CA 92408 K F <br />Phone <br />a <br />¢12. <br />Is - <br />Mo <br />Containers 13. Total 14. ik <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and to Number) Quantity Unit waste No., <br />G <br />No. Type Wt/Vol <br />a. <br />Non RCRA Hazardous Waste Solids <br />G <br />E <br />N <br />t4 <br />Wo IK I <br />V <br />EPAr <br />3 <br />E <br />R <br />b. <br />State <br />EPA/Other <br />T <br />�a <br />O <br />cm <br />R <br />C. <br />State <br />EPA/ <br />M <br />d• <br />State <br />Z <br />W <br />U <br />EPA/Other <br />W <br />Z <br />J. Additionat Descriptions for Materials Untied Above <br />K Codes for Wastes Listed Above <br />O <br />soil <br />a. b. <br />Diesel <br />W <br />a: <br />C. <br />d. <br />J <br />Z <br />O <br />16. Special Handling Instructions and Additional Information <br />Z <br />24 Hour Contact: Nick Hardin <br />24 Hour Phone: (714) U6-4081 <br />J <br />J <br />U <br />16. <br />_i <br />GENERATOR'S CERTIFICATION: i hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br />J <br />and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and <br />national government regulations. <br />IS <br />if 1 am a large quantity generator, 1 certify that i have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined <br />O <br />to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the <br />} <br />present and future threat to human health and the environment; OR, if I am a small quantity generator, i have made a good faith effort to minimize my waste <br />U <br />generation and select the best waste management method that is available to me and that 1 can afford. <br />Printed/Typed NameSignature <br />It <br />' r Month Day ,Year <br />M <br />W <br />I71 <br />LGP <br />-. .rlf.• '. C. <br />WT <br />R <br />17. Transpo er t Acknowledgement f Rece pt of Materials <br />A <br />Printed/T ped Name Signature Month Day Year <br />t� <br />O <br />Sl <br />P <br />C �` nl ! <br />W <br />O <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />UT <br />Printed/Typed Name <br />Signature Month Day Year <br />E <br />Z <br />s <br />19. Discrepancy Indication Space <br />F <br />13L0eV- <br />A <br />C <br />j4A q 36.0®7381 <br />L <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />/ <br />y <br />Pri/Typppd^Name <br />Signature ® Month Day Year <br />to A� <br />OHS 8022 <br />A Do Not Write Belol This line <br />EPA 8700-22 <br />(Rev. 8-89) Previous editions are obsolete. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />