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State of Cal4amic—Environmental Protection Agency Form Approved OMB No. 2050-0039 (Expires 9-30-99) PI print type F designed for use on elite (12-pikh) ril. h n N 6 O o) Q �u tin ax r�C 00d OD= �3 C a C a °u f s u l See Instructions on back o� 1 43 - . Repo m emof Toxic Substances Comrol i�l v Sacramemo, California ease pnn or Form e t 1. Generatar's U$ EPA ID No. Manihsl D«umenl No. 2. Page 1 Information in dm shaded areas UNIFORM HAZARDOUS it not repaired by Federal law. WASTE MANIFEST k D q _i<� % S G a W I of 1 3.. Gaoaw/afiin"ftAAddress CRRPEN-Tete P-0AAs ,at<c r r.I rsio - S7oCK7oPill rC& 4SLIS^$i0'e ,4. Generator's Phone (2o1 ) 4G5- 2 I fe -.L_1 J S. Transporter 1. Company Name 6. US EPA ID Number C Storz T nsporter's ID': 1 ECOLOGY CONTROL INDUSTRIES a 2 $ Q i 7 3 D Tran on — 610-236-13 - — -- 7. Transporter 2 Company Name S. US EPA ID Number :-Smt�T ponerrs lD ----- --`---•--'- ' 'h Tronsporter's Phone 9. Desi ted F.61i Nome and Sire Address 10. US EPA ID Number 'G. tate all'ay's ID ERIC�CSON Q. O G % 3 q 2- 253 PARR BLVD ocil,tys RICHMOND, CA 54801 p 9 4 6 6 392 35-13 + 12. Containers 13. Total I4. Unit 11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) No. T Quantity Wt/Val .,to Number'4 WASTE EMPTY STORAGE TANK, A Ste' Sat` 512 '� G Non-RCFRA hazardous waste solid PIPIa P P"'°thar 0 02 T 0% o Nrr;�L E<....- N b. E otb<r R T O Other R �- i ed. t '"a' s For _'Ab L .a At e s testa f i _ -,_ _ Ett? t , .. , C:F;AGE TANKi;>'7Z3, ...... TANIOS' HAVE_._.— ," DRY,IC[ PER TaC)0 GI4l.lON3 CA'At.tT�` i s lwP1 n4 19prote-14 eo 18 flit g when handle ' SITE LOCATION: SAA4( A4s A$ovr ear aPprop p 4 t9 S 4 Hour Emergency Telephone Number: 2cYi 4G5-ZbFL 24 Hour Emergency Contact C, 8Et2N0��S ERG# 171 ' 16. GENERATOR'S CERTIFICATION: Ihereby declare that the contents ofthis conirnmrstareFully and occuraMy described above by proper ship ing name and are classified, packed, marked, and labeled, and are in all respects in proper condition For transport lsy highway according to applicable international and notionargovernment regulations. If I am a large quantity generator, I certify that I have a p ram in place to reduce the volume and toxicity of waste generated ta the degree I have determined to be economical) ticoble and that I have selected the practicable method of treatment, storage, or disposal currently available to. me which minimizes the present and future threat to human he sit and the environment; OR, if I am a small pracquantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford. i V �r qme r %4''S Sig l (L Mon n DOY Year s T 17. Transporter II Acknowled a Bent of Receipt of Materials IVTY./, ��a1)i lnJ1 F 7J/ VI c R Pr Nam S' natureItIZ Y P 0 18. Transporter 2 Ac4rwwled ement of Receipt of Materials i Printed/TyW Name Signature Month Day Year � E 0 19. Discrepancy Indication Space v F ' = A C I L I 20. F«ili Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Ross 19. Priiypd/Jypedma Signature,` x _ w Iklostt ear DO NOT WRITE BELOW THIS LINE. f T�j �(]r�/{�` Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. DTSC 0022A 14/97) "�a s`D APR O 6 ps�, (Generators who submit hazardous waste for transport out-of-state, EPA 87022A ( produce completed copy of this copy and send to DTSC within 30 days.) DO NOT WRITE BELOW THIS LINE. f T�j �(]r�/{�` Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. DTSC 0022A 14/97) "�a s`D APR O 6 ps�, (Generators who submit hazardous waste for transport out-of-state, EPA 87022A ( produce completed copy of this copy and send to DTSC within 30 days.)