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State.of Cakfamki--Environmental Protection Agency <br /> Form Approved OMB Na.2030-0039(Expires 9-30-96) See Instructions on loath: o page 6. <br /> Please print or {� Department of Toxic,Substances Control <br /> p type. farm designed/or use on elite(t2pitch) 'rcr. Sacramento,California <br /> UNIFORM HAZARDOUS nerator's US EPA ID No. Manifest Document 1W 2. Page 1 Information in the shaded areas <br /> WASTE MANIFESTGAGrQ31 Z is nal required by Federal law. <br /> � I �` �1 � � <br /> 3. Generator's Name and Mailing AddressA 'Shifa Motile <br /> st Uocunrrnt Number : <br /> US A"I <br /> �IR� $wt' ��}JE 2t© urJpA GA '15613 5,59 <br /> F tf$i5tate.Generafols to ,�: <br /> 4. Generatar's Phone i� y�O , ?1 <br /> rsINI w ex <br /> O 5. Transporter 1 Company Name 6. US EPA ID Number <br /> O r, State Tro s ID� <br /> b'�+fi��r�o�sngs`p�artyeP�s Phone. w-�`��C 1 t, <br /> J' <br /> J 7. Transporter 2 Company Name 8. US EPA ID Number (�f <br /> E�Sfahi'TrassQorlet's TD <br /> d F,�Tr�arssp"arl�s' '•'"r�;� <br /> Z 9- Designated Facility Name and Site Address 10. US EPA ID Number F ily s ID g <br /> Vt lEr"+F\+ <br /> EERICKSON INC. ,�1Of1e <br /> 55 PARR BLVD. CADm094b6392Ll `jy � f 19.1 <br /> i R1QWMQAID, CA 94901 <br /> Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> Z No. Tyee Quantity Wt/VOI I,-zWoitd7J61` <br /> aState <br /> NON—RCRA HA AR 0US WASTE SOLID: WASTE <br /> G <br /> EMPTY STORA E ANK :' 1 <br /> EEPA Other <br /> 01 P I Tj P P <br /> 5 State .t; tAE ^i <br /> V R <br /> ? EPA/Ot(ser < -$ <br /> A <br /> T C. <br /> O ' <br /> LJ E•oA�OHrr J" �� <br /> y.r <br /> � d- <br /> FFA/Otfrer X <br /> -11 Addlitiorms!0esersptiewts for Mulrrtals listed Above" s-• w mss, : , <br /> A'-1 A yS ` � K HondPmq Cadet for Washn luted Aboi+tr f � ^f"• <br /> '4TY � LwENiPTYST�RAGE }TANK{S) ' �rf� " x '� 1" r -. <br /> n : r� f r a t <br /> krt wM Rt, 3 1!. s-1. S b. ¢ a` E <br /> "� `-i•F -Y "'1. -� %r? •"F.t �;'Y"�n•.�er1.^ T.�/��`Y ��JJ Yx.�" 7.+ .y,y� 2• /�" Via-. rk. ,4 .� _> �s � _ r <br /> Xf7NA11 r-7 f;•J_{ <br /> EEN,INERTED -WITH 15 LBS <br /> 3� <br /> DFtY 1CPEI:t ig00 yALLtIF�"CAPACITY: <br /> J 15. Special Handling Instructions and Additional Information <br /> KEEP AWAY FROM SOURCES OF IGNITION. ALWAYS WEAR 24 HR. EMERGENCY CONTACT <br /> 7 HARD HATS WHEN WORKING AROUND UGSTs. NAME: MAPV-I,'#tu.cck- <br /> 5W' > 1M('j ti�Iaf`L)P,T IJV.Ar- PHONE: 2 HSR. EME GgNCY PHONE <br /> r OE P.O. : OE JOB: <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above b proper shipping name and are classified, <br /> � Y P Pe PP n9 <br /> t packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and rational government regulations- <br /> If I arcs a large quantify generator, 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 <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> threat to human health and the errvironment; OR, 0 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that I can afford. <br /> Prinfed/Typed Name Signature monthDay <br /> X <br /> T .5, .C, C. 2 fC9 Ic IS <br /> R 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> u <br /> A Printed/Typed NameX III Signature Month Day Year <br /> 0 18. Trans otter Acknowlad emeM of Recei f of Materials <br /> L T Printed/Typed Name t• <br /> E _ignature Month Day Year <br /> R <br /> u 19. Discrepancy Indication Space I <br /> n <br /> 1 F <br /> J <br /> A <br /> Z C <br /> I i 'ham <br /> 20. FacilityOwner or O erator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. l <br /> Printed/Typed Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 8022A (1/95) White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 8700-22 To: P.O, Box 3000, Sacramento, CA 95812 <br />