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tCakfoneo�--Emironmereal Prahchon Agency <br /> pproved OMB No 2Q30-=9 pp."9.30,961 See Instructions an back of page G Deportniem of Toxic Substuins Control <br /> rim or tripe Fon-d—Vned for nae an obile f 12pddr)typewrder Sacramento California <br /> 1 Generators US EPA 10 No Manifest Documeru No 2 Page 1 Irdormalson in the shaded areas <br /> UNIFORM HAZARDOUS Is not by Federal low <br /> WASTE MANIFEST D Q L^i 7 �' 7 4G 7 of i FILE E L RGI A <br /> 3 Gat+erators Nome and MaiErV Address <br /> d Generators Phone ( ) I s T T k - <br /> � a e <br /> S Transporter 1 Company Name 6 US EPA ID Number <br /> ERICkSON r 1MC �: �! is c) z� :+ tr +, ; ► ? <br /> Q 7 Transporter 2 Company Name 8 US EPA ID Number <br /> V v <br /> }9 R'gtatod�FaukrtyIName and SAe Sidle 10 US EPA ID Number% <br /> O )88( i <br /> LL <br /> -1 t. <br /> -Er -Rig, i45ea l T 4 1 8 <br /> ` 12 CorAamers 13 Total lI Unit <br /> 11 US DOT Description(includmg Proper Shipping Name Hazard Class and ID Number) T Quoty Wt/val <br /> t- <br /> G <br /> E <br /> N b <br /> E <br /> R <br /> A <br /> T c <br /> D <br /> R <br /> d <br /> U <br /> i;p.}yidffnp Codas for WFiea <br /> x.a r <br /> 15 Special Handling Instructions and Additional Information i J. I< <br /> r <br /> r <br /> 16 GENERATOR 5 CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified <br /> packed marked and labeled and aro in all respects in proper canddwn for transport by highway according to applicable international and national government regulations <br /> If I am a large quantity generator I certify that I have a program in place to reduce the volume and toxraty of waste generated to the degree 1 have determined to be <br /> Qeconomically practicable and that I hove 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 environment;OR if I am a small quon*ty generator I have made a good earth effort to minimae my waste generation and select the best <br /> waste man einem method that is available to me and that t can afford <br /> PnriMd/Typed <br /> Name `^ SignatureMonth Day YeOi <br /> r <br /> V <br /> t17 Transporter 1 Acknowledgement of Receipt of Materials - _r-y ` <br /> Month Dox �aar- <br /> !l PripNd/Typec�Noise` ) 4nah+re ] r <br /> Wp 18 TroM22rter 2 Acknowledgement of Recap!of Materials <br /> APrinted/Typed Name Siq-ahrro Month Day Year <br /> t E <br /> A <br /> 19 Discrepancy Indication Space <br /> Q F <br /> V A <br /> C <br /> I <br /> L <br /> 20 Facil Owner or operator Certification of receipt of hazardous materials covered by this manifest except,as noted in Item 19 <br /> PnntadJTyped Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE <br /> IOTSC 8022A (1/95) 'low -ENERATDP RETAINS <br /> EPA 8700-22 <br />