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State of Califonslo nvircnmemol Protection Agency <br /> Fpr-Appraised OMB No.2050-0039(Expires 7-3094) See Instructions on back of page 6. Departm.nt of Toxic Substances Con,, <br /> Plea.prim:or type. form designed/or use on elite/12-pik swrrfer. 1, Z-3 socram nsho,California <br /> UNIFORM HAZARDOUS Ganeraror's US EPA ID No. Manifest Document 2. Page 1 Infomeorce,in the shaded areas <br /> s not required by Federal law. <br /> WASTE MANIFEST ITI/IC lia3 11 1.4 1 1of <br /> 3. Generator's Name and Mailing Address r <br /> PRcIrIcBELL 9323 <br /> dico coat/*& RawV, Rm a�asp�sA��mo v, <br /> ,'n4. Genarolot" Phone (lfldS) V' S3 <br /> a <br /> S. Transporter 1 Company Nome 6. US EPA ID Number e Tmnsporte�s ID as <br /> L(C s Goy a l+f ^I a ranspartei's.Pl,ppe, ..p,�d J <br /> J717 ", <br /> 7. Transporter 2 Company Name 8. LIS EPA ID Number Tronsponi ID ' <br /> V <br /> Tansporter`s;Phorre <br /> Q 9. reeled F«il' N and Site Address 10. US EPA ID Number tote F«iY:ys RD <br /> Z tS1CKSOr�Rc. <br /> h 255 Parr Blvd. (II ,x Phone <br /> Q RichniondrCA. 94801 C A D 0 0 9 4 6 6 3 9 2 5-133Feet <br /> ^� U 12. Containers 13. Total 14. Item <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Cunt,and ID Number) No. T Qr Wt/Vol �LLV✓aae Number -+z <br /> NON-RCRA Hazardous Waste Solid 12 <br /> 3 G Waste ESnpty Storage Tank. U T <br /> E P 0/160 P <br /> m N Is. <br /> goE <br /> aR a/Gda <br /> A <br /> T <br /> gP O <br /> R <br /> W <br /> Z d. <br /> W <br /> U <br /> W <br /> N <br /> Z <br /> O <br /> a <br /> N <br /> W <br /> J <br /> Q <br /> 0 15. Special Handling Instructions and Additional Information <br /> t- Keep away from sources of ignition. Al ys wear harcliats when working around <br /> Z U.G.S.T. 's 24 Hr. Contact Name.Q9� 1.4 Phone.! QZQ <br /> S E Jeel,1-,111- 1 ;3 T .-CAreV C+17C7FC- c rs 'nz <br /> J 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fvlly and accurately described above by proper shipping name and reclassified, <br /> J <br /> pecked,marked,and labeled,and are in all rez proper condition for transport b highway according to applicable federal,stole and international laws. <br /> Q P Pects in PrP P° Y 9 Y act 9 PP� <br /> U <br /> If 1 am is large quantify 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 <br /> J 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 /> G threat leo human health and the environment;OR,if I am a small quantity generator,I have made a good faith effort b minimize my waste generation and select the best <br /> N <br /> � waste management method that is avoilabk to on,and that I can afford <br /> O Primed/Typed Nome Signature y M nth r Day ,Y.r <br /> ZT 17. Trc r 1 Actino mem of Receipt of Materials <br /> O N DYe <br /> Primed//feed/Name SigraN Momh ay r <br /> feu C A ��n•Li ( _ '/'; s.�" L <br /> 0 18. Tramparter 2 Acknowledgement o1 Recei t of Materials <br /> W <br /> Is Prinked/Typed Name Signature Month Day Year <br /> O e <br /> W 19. Discrepancy Indication Space <br /> N <br /> Q F <br /> U A <br /> Z C <br /> _ I <br /> L <br /> I 20. Facility Owner or operator Cendkation of receipt of hozordous moterials covered by this manifest except as rated in Nem 19. <br /> T /Typed Name Siga�/w�re, Momh Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (7/92) <br /> EPA 8700-22 <br />