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l Stake of CalRomio—EmAna memal Protection Agency <br /> Form Approved OMB Ho.2050-0039(Expires 9-30.94) See InSTTwt:TlenS 011 back loge 6. D.partmSc rc Toxic e subaamia Com <br /> Please print or type. Form designed for use on elite(12P�+�rewr(ter. - Socronensh CaliForrca <br /> 1. Ganerarors US EPA ID No. Y Manilesl Document No. 2. Page 1 InlormaBon w the shaded arem <br /> UNIFORM HAZARDOUS C A D 9 8 1 4 5 9 9 4 4 3 7 8 8 5 1 of l a rat required by Federal low. <br /> WASTE MANIFEST <br /> ' <br /> r 3. Ge e,coor's Nome and Mailing Address <br /> o Santa Fe Railway <br /> n P O Box 1947 S o e G nera ox's ID <br /> Fresno, CA 93718 <br /> Vtr14. Generator's Phone (209) 441-2564 <br /> mh A n: Charlie Armenta <br /> 00ts me 5. Transporter 1 Company Na6. US EPA ID Number Store Trompor/er's ID <br /> 00 Erickson, Inc. C A D 0 0 9 4 6 6 3 9 2 Ttansporter's Phone 7 <br /> (510) 235-1393 <br /> C7. Transporter,2 Company Name S. US EPA ID Number Stare Transporter's ID <br /> � '^ a <br /> Y' V Sfiransporter's Ph. <br /> I $tare Facility's ID <br /> 9. Designated Facility Name and Site Add10. US EPA ID Number <br /> O0 Q ress <br /> N Chemical Waste Management <br /> 1t M 35251 Old Skyline Road ys <br /> N a -971f <br /> 12. Containers 13. Taal 14 Unit <br /> M U <br /> (T Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. T Oonfity Ws/Vol Waste Number <br /> State <br /> 3 Non RERA hazardous waste solid <br /> j N E (Absorbent pads with hydrocarbons) D P EPA/Other <br /> tinviss <br /> I N b. StO1B <br /> REPA/Oche. <br /> A <br /> b O c. <br /> $nme <br /> I <br /> EPA/ her <br /> � R <br /> l d. FEPA�/CAc, <br /> Z <br /> W <br /> V <br /> ii W <br /> W ..Hondlirrg Codes for Wastes Liaed Atom - <br /> - Z J. Additional Descriptions for Matedals Listed A <br /> 0 I Pzof11e4 AK 719 a b <br /> r <br /> KLillt> C. d. <br /> Q <br /> r Q 15. Special Handling Instructions and Additional IrrMrmation <br /> ` a Wear gloves, goggles and appropriate personal protective equipment when handling. <br /> 'i Z Emergency contact: Charlie Armenta (209) 441-2564 <br /> W <br /> w <br /> = Site: Werner/Orwood Station. Orwood Road east ot Bixler Road. <br /> � 16. GENERATOR'S CERTIFICATION: Thereby declare the the contents of the consignment am lolly and accurately described above by proper shipping name and are classified, <br /> Qpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,sfof and international laws. <br /> V <br /> � If 1 am a longe quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be <br /> J economically practicable and that 1 have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> 1 threat to human health and Bre environmern;OR, R 1 am a small qua"generator, I have mode a good faith effort to minimize my waste generation and select the best <br /> N <br /> waste mares ement method the is available to me and the I can afford. <br /> O Printed/Typed Nme aSignature Month Day Veaer r <br /> y <br /> V s 17. Transporter 1 Acknewlad ment of Recei i of Materials <br /> e <br /> VrN Printed/Typed Name Sigpssture Mart Day Year <br /> w s <br /> P <br /> 1 a 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> W 8 Printed/Typed Name Signature Montle Day Year <br /> O e <br /> e <br /> W 19. Discrepancy Indication Space <br /> N <br /> F <br /> U <br /> V p <br /> I Z C <br /> t <br /> { l <br /> 120. F.cilm,Owner or Ocerator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name $iOnatere Month Day Year <br /> Y r <br /> DO NOT WRITE BELOW THIS LINE. <br /> i Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A (7/92) (Generators who submit hazardous waste for transport out-of-state, <br /> EPA 87 22 produce completed copy of this copy and send to DTSC within 30 days.) <br /> DTSC 8022A (7/92) RECEIVED AUG D 1 'SB4 <br /> EPA 8700-22 <br /> Green: MAULER RETAINS <br />