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/ Sate of Calfiomia.-Enwarred Probclian Agnry Y:: L v.:•••== (f <br /> Form aced UMR tQ 2450-m39.(Eapirw 9.30-91) See Instructions on back o,,.Age 6. ' U Lporlmee of Task svb roti.Centel <br /> &-FrZw p m w Form dodge d far uw m okte(12yitd O/ Sacmrmeoc.California <br /> "'UNIFORM HAZARDOUS 1. Gfnararols US EPA ID No. ) Mwd"Donmedo.N 2. Page 1 ofonnalion in the shoded <br /> h areas <br /> not required by Federal law. <br /> WASTE MANIFEST of <br /> 3. Gerwrct.r s Name and Mailing Address ,��polfGrn!bnf .. <br /> h Santa Fe Railroad <br /> ril 740 Carnegie Rad, San Bernadino, CA 92408-3571 <br /> n <br /> A. Generate:.Phone (209) 441-2521 <br /> m <br /> A 5. Transporter 1 Company Nome 6. US EPA ID Number <br /> m Erickson, Inc. IC A ID 10 <br /> 10 19 14 16 1613 <br /> raw •3��' <br /> J <br /> < 7. Transponar 2 Company Name 8. U5 EPA ID Number 7 <br /> U .. ...S1s:y.e /Zv/GG,E� SNL AD gra i _ .. a ► {a. <br /> ("Z9. Designated Facility Nems and Site Address 10. US EPA ID Number ^;Shea FoelyfA T'' <br /> do U.S. Ecology <br /> V-4L- Hap. 95 12 Miles S. of Beatty 1f 'F.WsMoe <br /> NVT33001 <br /> �� NV 89003 - <br /> Go Cyz 11. US DOT Description(including Proper one, an,anNumUnt <br /> Shipping NHazard Class. ID ber) 12. Comonen 13. Total 11. <br /> No. T Wt/Vol <br /> N~ a. Nun lICItA tLezatldoos Neste So11d <br /> �o E IC D I M <br /> Wm Nb. <br /> i E sora , <br /> n R A� y <br /> I A C , <br /> �j <br /> tY R EPA�QIfws- <br /> Zd 4 <br /> U <br /> Dew4tooi Yar A1oMials lis)ed Ahew .r•.w 6 O�y <br /> f'�-rrnv'1fc ' Codes,fo"„r W'" I_sd <br /> a7 ,Va� 1 ! <br /> ,. <br /> .. t�J4� t+�.�.... 4 ^' '?4 .•x��^w+ 4f'� � � �. <br /> Q 15. Special Handling Insavetions and Additional Information <br /> i Gloves and Goggles 24 Hoa COE1IaC'tR I'°yl yy/- 1 SGG Sfi�C <br /> NSR c � p:IrKer' <br /> t- - PtEona(1_,y Z <br /> 16. GENERATOR'S CERTIFICATH)N: 1 hereby dation that the contents of the consignment aro fully and oc ,r y dncn above by Proper shipPing none and ars clossified, <br /> < pocked,marked,and labeled,and an in all respects in proper condition for transport by highway according b applicable federal,sns and international Imes. <br /> U <br /> If 1 am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste ganmated to the degree 1 have delermned to be <br /> d economically practicable and that 1 have wlecmd the practicable method of IrsotrreM,storage,or disposal curnenty available tome which minimizes the present and future <br /> m <br /> V) threat to human health and the enviroent;OR,9 1 am a small quantity generator, I h.made a goad faith effort to mnim'¢e my waste gererahon and select the best <br /> waste management method that is avoioble to me and that I can afford. <br /> Printed/Typed Name Signaore <br /> U M r �' V✓ . /C N I 7� 'T.!/•`� Merle DYear <br /> Z T 17. Transporter 1 Acknowl mens of Receipt of Materials <br /> A Prised/T f Signet Year <br /> Alerlh <br /> D <br /> W l/- ay <br /> W e J <br /> O 18. Transporter 2-AcknowWasmen,of Re6ipt of Materials <br /> 0 T Primed/Typed flame Signoon - _ month Year <br /> O ST <br /> h 19. Discrepancy Indication Space <br /> U F _ <br /> A <br /> Z I <br /> 1 <br /> t <br /> 1 20. Fm7 Owner or Operator Certification of receipt of haardaus materials covered by this manifest except as noted in Item 19. <br /> Preaed/Typed Nana Sioo <br /> nure <br /> Y A1anth <br /> / Day Year <br /> DO NOT WRITE BELOW IS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHINnOD <br /> DTSC W22A (12/91) (Generators who wbmh hazardous watt for tronspstate, <br /> EPA 8700.--72 roduce completed co <br /> p p pry of this copy and send to DTSC within 30 days.) <br />