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co <br />CDC <br />r-I"- <br />LC?t`, <br />L(7 <br />003 <br />M6 <br />C <br />a <br />a <br />d <br />C <br />a <br />C <br />H <br />2 <br />L <br />4 <br />Z <br />C <br />Zz <br />w <br />r_ <br />4 <br />V <br />J <br />h <br />L <br />U <br />W <br />W <br />0 <br />Q <br />w <br />sn <br />U <br />U <br />Stora o California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-99) See Instructions On back OF page b. De ortment of Toxic Substances Control <br />Please print or type. Form designed for use on elite N2aik _writer. f--, n �»e2 P <br />DO NOT WRITE BELOW THIS LINE. <br />Wh9f . TSDF SENDS THIS COPY TO DISC WITHIN 30 DAYS, <br />EPA 877000-- 22 <br />DISC 0Id/9ll To. P.O. Bax 3070, Sacramento. CA -5812 <br />UNIFORM HAZARDOUS <br />Generator's US EPA ID No. Manifest Document 2. Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />� / �y � / <br />s not required by Fedaral low. <br />o 6 I $ Y1 of 1 <br />3. Generator's N me and Mailing Add s LL V._!x0 <br />MAY -,A- 7 <br />A. State Manifest Document Number <br />98455166 <br />r gp-15 fl .0 Ai -"Y .s`j. s-fo'<* fvt) C�-p 75 91 5 <br />B, Stare Generator's ID <br />p <br />4. Generator's Phone (2 G / 1 ?.? "' C <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C, State Transporter', ID <br />FULLER EXCAVATING AND DEMO 7 A <br />/ 9 <br />D. Transporw,'s Phone Q1 C-�CQ-Ogo^ <br />sY V i7V OJ V <br />7. Transporter 2 Com Name <br />P° Company 8. US EPA ID Number <br />E. State Transporrer's ID <br />I <br />F. T,.nspo'der:'s Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. Stare facility's ID <br />ERICKSON INC. <br />G A- 0 0 Rq 6 6 3 <br />255 PARR BLVD <br />H Fadcty's Phone <br />RICHMOND, CA 94801 CAM089 <br />510-235-1393 <br />11. US DOT Description mcludin Proper Shipping <br />p ( g pe Aping Name, Hazard Class, and ID Number) <br />T2. Comahcr: <br />13. Total <br />I4. Ualt <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />I. Wash, Number <br />WASTE EMPTY STORAGE TANK <br />StOfe <br />512 <br />E <br />Non-RCRA hazardous waste solid <br />TP <br />® <br />p <br />EPA/Other <br />NONE <br />b. <br />N <br />srota <br />E <br />EPA/Other <br />R <br />--- ---- -—--- - -- :..�.- <br />----'-- <br />- <br />-. <br />- <br />A <br />T <br />O <br />l-IJIV9H 1Y11V Vit"f y! <br />9.1 <br />Statefe <br />EPA/Other <br />R <br />d <br />Stare <br />EPA/Other <br />h <br />J. Additional Descriptions for Materials Listed Above - <br />K. Handling Codes for Wastes tilled Above <br />OTY.__�, EMPTY STORAGE TANK(S) <br />a <br />. TANK(S) HAVE BEEN INERTED WITH <br />r <br />d <br />15 LBS DRY ICE PER 1000 GALLONS CAPACITY. <br />15. Special Handling Instructions and Addllionol Information <br />Wear appropriate protective clothing when handling. SITE LOCATION: <br />24 Hour Emergency Telephone Number: <br />24 Hour Emergencv Contact: ERG 17 <br />16. GENERATOR'S CERTIFICATION: Ihereby declare that the contents of this consignment are fully and accurately described above by proper ship ing nameand are classified, Pocked, <br />marked, and labeled, and are in all respects in proper condition For transport 6y highway according to app lica6le international and notionaPgovernmenr regulations. <br />If I am a large quanliy genervror, 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 economicallyy <br />Practicableand 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 h.19 <br />and the environment; OR, if I am a small quantity generator, I have made o good faith effort to minimize my waste generation and select the best waste management method that is <br />available to me and that I can afford. <br />Printed/Typed Name <br />tau, r s- dr <br />Signature <br />% <br />Month Day Vear <br />? <br />o o <br />T17. <br />Transporter 1 Acknowled ement of Receipt of Materials <br />E <br />Printe/d�/Typad�a' a s <br />SignaNre <br />r <br />Month �RDay ljyear <br />P <br />1// <br />�../ /® r t��:S <br />p <br />v <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />TPrinted/Typed <br />Name <br />Signature <br />Month Day Year <br />E <br />R <br />79. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials <br />covered by this manifest except as noted in Item 19. <br />T <br />T <br />Printed/Typed Name <br />D/tD <br />Signature <br />Month Day Year <br />D <br />DO NOT WRITE BELOW THIS LINE. <br />Wh9f . TSDF SENDS THIS COPY TO DISC WITHIN 30 DAYS, <br />EPA 877000-- 22 <br />DISC 0Id/9ll To. P.O. Bax 3070, Sacramento. CA -5812 <br />