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Stale of p.!ivemi MB Yirrnmental Protection Agency <br /> Form APPn+s'ed OMB No.2050-DD39(Expires 9.30.94) <br /> Please print orlype. Form designed for uw on effM(12puch)Ar, SOB IOftIYCtIOOf 00 back 6f'i& 6. <br /> Depvrfinent of Toxic Substances Control <br /> + Sacramento,California <br /> UNIFORM HAZARDOUS 1• Gene stors US EPA ID le. Manifest Document No. 2. Page 1 Information in the shaded crews <br /> W YS I E MMNIFEST is nail required by Federal law, <br /> 3. Generator's Noma and Mailing Address C D 9 8 5 6 8 of <br /> o Falcon Energy Associates hbnfee ber <br /> in <br /> P.O. Box 1257 j <br /> N Stockton, CA 95201 Stab Generators ID <br /> in 4. Generator's Phone ( ) <br /> 5. Transporter I Company Name 3 61014111313121 <br /> ' <br /> 6. US EPA ID Number . Stam Tmmporfer's ID <br /> 00 400765 <br /> Falcon Energy Associates CAD 9 3 2 5 2 6 8 5 7 T,.mpa1 is Phone <br /> 7• Tra sporter 2 Company Name <br /> (209) 463-7108 <br /> VB. US EPA ID Number State Transpurfer's ID <br /> Q T...Poster's Phone <br /> Z 4 u ated F«il'sps Name and Sib Address 10. US EPA ID Number <br /> z lr°fc°&son, Lac. stab Focility`s ID <br /> Q 255 Parr Blvd. <br /> 0 <br /> u Richmond, CA 94801 Facility's Phone (510) 235-1393 <br /> CAD 0 0 9 4 b b 3 9 2 <br /> Z 1 I. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers X13.Notal 14. Unit <br /> _ NON &CRA Haaardous Waste, Solid Na. r Guamf Wt/Vol Number <br /> 3 G (Waste Empty Storage Tank) State 512 <br /> N E 0 0 3 T PE <br /> oDD N 6. P Y'8 +lone <br /> cO E stab <br /> e It <br /> T c TEPA/Other 7 <br /> 40 <br /> O ae <br /> R —� <br /> PA/Other <br /> Z d. <br /> UState <br /> y, <br /> W <br /> N <br /> 'EPA/Other ~ <br /> ZdlerA Listed Above <br /> a Pistilli 1 <br /> P y Storage Tank (a). f 13261 , 13262 ,13263 a.. .'tar Wat,e6Listed Aba,e <br /> xk (a) have been inerted with 15 lbs. Dry Ice per <br /> 00 Cal: Capacity <br /> Z <br /> Q a <br /> ,.w,... a F ..+., ..... -'�. <br /> Q 13. Sp«:°I Handling Instrvtlions and AddBonal Information Hour Emergency Response Numb!r' <br /> Z Falcon Energy Associates <br /> Keep away from sources of ignition. Always wear hardhats when <br /> working around U.S.T. 's <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment arc fully and accurately described above by proper shipping name and are classified, <br /> Q <br /> pocked,marked,and labeled,and ore in all respects in proper condition for transport by highway according to applicable federal,style and international laws. <br /> J <br /> .S If I am a large quantity generator, 1 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 /> Y <br /> economically practicable and than I have selected the practicable method of tieatinent,store e,or disposal sposal carcMly available b me which minimizes the present and fuNre <br /> threw to human health and the environment; OR, 8 I am a small quantity net I h made a faits e N b minimi: my w generation and select Me bast <br /> 1, waste mono anent method that is avcilabte b me and that I can afford. a IateB <br /> Pe1TL "had 02 )Pa°�coagner e�ssoc <br /> Printed/Typed Name SigrwNre Month <br /> Z T 17. Trans fret 1 Ackrawled ament of Racei tot Materials <br /> Z <br /> " A PntedT <br /> rJ `ypssd Name <br /> N Signature <br /> 41 MonthDay Yaar <br /> L ria 18. Tanbd <br /> Trona rr 2 Anowled anent of Recei t of Motariah <br /> u_ F Pdnled/Typtsd Nome SignaNrc <br /> Q a Monts <br /> Day Year <br /> N 19. Oiscropanry Indication Space ' <br /> V p j <br /> Z � <br /> L <br /> 2 «iP Owner or r Certification of rocei t of hazardous material <br /> s covered b this manifest ex .as noted in feet 19. <br /> Y Pr \ /(z�yped No", Sirature ' <br /> 4 ( �1 Month 'DaYr. Year <br /> DO NOT WRITE BELOW THIS LINE. ' r. <br /> s <br /> DISC 80229. (7/92) <br /> EPA 8700-22 <br /> Green: HAULER RETAINS <br />