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q <br />v <br />9 <br />s <br />l <br />u <br />�U <br />J <br />W <br />State of California—Emiranmenlol Protection Agency — - <br />Form Approved OMR No. 2050-0039 (Expires 9.30.94) See Instructions on bad 1309�, Dapartmam of Task Substances Coon <br />Please prim.or type. Form designed toe use on elite (11pi1t/pewrim. mere, * :% 1A0 Sacramento. California <br />DT5C 8022A (9/93) <br />EPA 8700-22 <br />DO NOT/WR�TEI BELOP Ti f$ CINE. <br />I <br />UNIFORM HAZARDOUS <br />1 Generator's US EPA ID No. Manifest Document No. 2. Page 1 I <br />Information in the shaded areas <br />is Cwt required by Federal law. <br />WASTE MANIFEST <br />Ct U 6 0 0 6 8 7 aft <br />p0�7/ <br />3. Generabr's Name and Mailing Address <br />mit b urb a a rc u.n � <br />A. Slate Manifest Document Number <br />93.480 59__ <br />-?Jgei-5 L Muw& <br />R State Genarato;:ID <br />� -417P <br />4. Generator's Phar. <br />JS % <br />5. Transporter 1 Company Nome 6. US EPA D Number <br />C. State Transporter', ID 428261 <br />CAD982438566 <br />_ <br />D. Transporfe", Ph. e <br />ao 687-1292 <br />De.xi%nng, Ltd. <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />_ <br />E. State Tronsporier's ID <br />F. Transporteh Phone .. <br />9. evilly Nie and Site Address 10. US EPA ID Number <br />ET1CKSoc1, 1ric. <br />G. State acility's 10 <br />255 Parr Blvd. <br />H. Facility', Phone - <br />(510)235-1393 <br />RichTllond,CA. 94801 <br />11. US DOT Description itch Proper Shi n Nome, Hazard Class, and ID Number <br />(includingPWB ) <br />12. Containers <br />13. Total <br />14. Un I <br />No <br />Type <br />I Quant' <br />WI/Vol <br />I. Waste Number <br />a' NON-RCRA Hazardous Waste Solid <br />5tot'S12 <br />Waste Enpty Storage Tank. <br />T P <br />P <br />EPA(j4WE <br />E <br />�� <br />O � <br />N <br />b. <br />State <br />E <br />R <br />EPA/Other <br />T <br />a <br />,tam <br />O <br />R <br />EPAjaha. <br />d. ...� — <br />`Smte <br />EPA/Other <br />c) Ihopul b,scriptiphsfor Materials listed Above <br />S2 Y._L=Bnpty Storage Tank(s)W4ZJZ1r_�, �', <br />K. Handling Codes for: Wa{tet <br />a. <br />Listed Above <br />b. <br />-Tank(s);have been inerted with 15 <br />0/ <br />�11D,s,Dry Ice Per 1000 Gallon Capacity, t <br />C. <br />d. <br />15. Special Handling Inslntcagts and Addii .I IufurmoGon <br />Keep away from soLuces of ignite. Always wear her Bits when working around <br />U.G.S.T.'s 24 Hr. Contact Name. )� _& Phon - S <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and arc classified, <br />packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br />If I am a large quantity generutoa 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 <br />economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future <br />threat to human health and the environment; OR, if I am a small quantity generator. I hove made a good faith effort to minimize my waste generation and select the best <br />waste management method that is available to me and hat an afford. <br />' ed/Typed Name 4Q <br />ff' nature <br />Month Day Year <br />L-ce <br />,' .t <br />6 1 % 1712 1'k <br />T.Trans <br />rter I Acknowled ement of Recei 1 of Materi s <br />A <br />Printed/Typed Nome <br />Signature <br />Month Day Year <br />L. F. DeKalb <br />(` �. <br />rJ <br />0 <br />ePrsnfed <br />18. Transporter 2 Acknowled emert of Receipt of Materials <br />I <br />/TYP ed Name <br />Signature <br />Month Day Year <br />F <br />P <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />I. <br />1 <br />20. aci' Or or Clr tar Certification of recei t of hazardous materials c vered 6 Ihis m est ex t as noted in Item 19. <br />T <br />Pr ed/Typed Nome / R I Sign ra <br />Momh% Day Year <br />DT5C 8022A (9/93) <br />EPA 8700-22 <br />DO NOT/WR�TEI BELOP Ti f$ CINE. <br />I <br />