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cok <br /> I State of Cafifomia-En onmsml"ectwn Agency See Instructions on back__,page 6. Depare^e°t of em Subaornia Com <br /> Form Approval OMB No t 050-=19(Espires 9-3094) » .... ( Saaasnemo,California <br /> Please prim or sype. Form despned for use on elfie(121,i")In"wriM. shaded onean in the <br /> 1. Generatols US EPA ID No. Manifed Document No. 21 Page 11 R°f�mired by Federal Iia+. <br /> UNIFORM HAZARDOUS CO A D 9 8 1 4 5 9 9 4' 41 3 7 8 8 of <br /> { yt, WASTE MANIFEST <br /> I > }3. Generaror's Nam and Moiling Address ' <br /> Santa Fe Railway <br /> C 4 0 Box 1947 <br /> t n Freanor CA 93718 <br /> ` n 4. Generalor'sPhone (209) 441-2564 Attn: Charlie Arementa <br /> W <br /> 5. Transporter 7 Company Norrie 6. US EPA ID Number <br /> Erickson, Inc. CAD 0 0 9 4 6 6 3 9 �2. <br /> 7. Transporter 2 Company Nome R. US EPA ID Number <br /> Q i <br /> + 00V <br /> { co Q 9. Designated Focil'�y Name and Site Address 10. US EPA ID Number <br /> Z Advanced Environmental Technology <br /> }k � 0 1125 Hensley Street <br /> 4 N a Richmond, CA 94801 CAT 0 8 0 0 1 4 0 7 9 <br /> m V - 12. Containers 13. Taal U. Unit <br /> T Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) NO. T Wt/Vol <br /> Ve Non RCRA hazardous Waste splid <br /> 3 G (Non DOT regulated) D tl p <br /> o Eq <br /> E b. <br /> a R <br /> A <br /> T r. <br /> m 0 <br /> R <br /> W <br /> Z d. <br /> V <br /> W <br /> Z <br /> 13 <br /> O <br /> e <br /> a Ila) 'Part A epoxy <br /> Z _ '15. Special Handfirsg Instructions and Additional Information _ 7; <br /> Wear glvoes, goggles and appropriate personal protective equipment when handling. <br /> Z ,Emergency contact: Charlie Armenta (209) 441-2564 <br /> W <br /> site: Werner/Otvood Station Orwood Road east of Bixler Roads <br /> i 16. GENERATOR'S CERTIFICATION: I hereby declare that the contends of the comianmeM are fully and accuratelydescribed an.by Proper shipping more and ore clasdfmd, <br /> re in all respects in proper condition for transport by highway according to applicable federal,stab and international laws. <br /> packed,marked,and labeled,and a <br /> U <br /> J If I am a large quantity generator, I certify that I have a program in plow ro raduw the"Imes and rozwrr of waste generated ro the degree I have Present <br /> Ind u be <br /> economically practicable and that I haw selected Bw practicable method of treatment,storage,w dispersal currendy available ro ms which minimizes Ilia preuM grid future <br /> ydj threat ro human heabh and dbe envirortmerk;OII, N I am a small quantity generator, I how made a good faith effort ro minimae my waste generation and select the best <br /> waste man nNnI method that is available to me and that I can afford. <br /> O Printed/Typed Home Signature Mon h Day Yea <br /> > itrLLe s �9, d¢.tn - fx 01 <br /> 001 <br /> i Z r 17. Trans rter 1 Acknowled motif of Recei of Materials yen <br /> A Pri�yped Nome Sig 0 <br /> W r <br /> . O NkJ O I, C f�SSS <br /> o is. Tra anter 2 Acknewbeinem of eof Recei of Materiah Month Day Y. <br /> W R PrimeSignature/Typed N6rne Signature <br /> LL e <br /> O <br /> W 19. Discrepancy Indication Space V <br /> N <br /> V A <br /> - 1 <br /> 1 20. Facil' Owner or tifi <br /> rater Cercation of receipt of hazard s materials covered b in Iletin 19.' <br /> T <br /> Printed/Tsoei . (AcM "QN Si <br /> Q <br /> Y�E77 sem% <br /> DO NOT WRITE BELOW THIS UNE. <br /> * Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> T DTSC 8022A (7/92) (Generators <br /> b <br /> who submit hazardous waste for transport outrof-sta , <br /> EPA 8700-22 produce completed copy of this copy and sand to DTSC within 30 days.) <br />