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r State of C.lifornia—Environmental Protection Agency Form Approved OMB No. 2050-0039 (Expire: 9-30-99) L See Instructions on back of pag Department of Toxic Substances Control Please print or type. Form designed for use on elite (12 -pitch) typewriter. 'OSS ( Sacramento, California a CDS o �� �U U')z +a H Z U DO NOT WRITE BELOW THIS LINE. While TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS_ DTSC 8022A (4/971 �a. P O E,, 10,90 ,CA 95812 EPA 8700-22 1. Generator's US EPA ID No. Manifest Document�-2. Page 1 InFormafion in the shaded areas UNIFORM HAZARDOUS m requiredby Federal law WASTE MANIFEST CIAC1 a C) I I 13 1,211 3. Generator's N me and Mailing Add s y' A. State Manifest Document Number Yq -0--5 �� a 9 51 y y} Q�9 �y 04 s 24rls n 6 M -FY S-1, S -f %U� s -"'''e r^/ '" "' B. Stole Generator's ID A. Generetor's Phone (IV, 9) q '^ o I I I I I I I I 5. Transporter 1 Company Name 6. US EPA ID Number C, State Transporters ID FULLER EXCAVATING AND DEMO 7 1 6 T,mr,or`e" Phone 916-858-8300 7. Transporter 2 Company Name 8. US EPA ID Number E Sfat Tramponer's ID F T spotter's Phene —� 9. Designated Facility Name and Site Address 10. US EPA ID Number I G. State Focilily's ID ERICKSON INC. j�{'[�'D� 255 PARR BLVD i H. I'm6lity's Phone RICHMOND, CA 94801 ___ __ __ 510-235-1393 12. Conminers 11. US DOT Description (including Proper Shipping Nome, Hazard Class, and ID Number) No. Type Ouanfity, wt/'✓;I I. Waste Number WASTE EMPTY STORAGE TANK state 512 �- P =PA/other NONE EB N stare E R EPA(Olher T c state O R EPA/Other d. Slate - LL -._ 1_J._1 'EPA/Other -- - —-- — - — ). Addition I Descriptions for Materials Listed Above - K, Handling Codes #or Waite, Listed Above QTY. 1 EMPTY STORAGE TANK(S) it ( d. - . TANK(S) HAVE BEEN INERTED WITH Ac 15 LBS DRY ICE PER 1000 GALLONS CAPACITY._ 15. Special Handling Insaudions and Additional Information Wear appropriate protective clothing when handling. SITE LOCATION: 24 Hour Emergency Telephone Number: 24 Hour Emergencv Contact: ERG 17 16. GENERATOR'S CERTIFICATION: Ihereby declare that the contents of this consignment are fully and accurotely 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 nationaPgovernment regulations. If I am a large q antiry generator, I certify that 1 have progrom in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economicallyy and that I Gave selected the practicable method o treatment, storage, or disposal currently available to me which minimizes the present and future tweet to human healM pro and the environment; OR, if I am a smell quantity generator, I have made a good Faith effort to minimize my wosto generation and select the best waste management method that is available to me and that 1 can afford. Printed/Typed Name tb� r Cdr Signature Montle Day Year a T 17. Transporter I Acknowlodgement of Receipt of Materials R A Printed/Typed, NaTme t Signature ( Mends �pDay ear 0 18. Transporter 2 Acknowledgement of Receipt of Materials R T Printed/Typed Name Signature Month Day Year E R 19. Discrepancy Indication Space F A C L I1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 79. T 1' Printed/Typed Nome D4 l ( Signature �r Vv—d'- I � Mark Day Year D121 23�jq DO NOT WRITE BELOW THIS LINE. While TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS_ DTSC 8022A (4/971 �a. P O E,, 10,90 ,CA 95812 EPA 8700-22