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roan HPV""d OMB No 2050-0039 1Expfre3 9 30 9yl d�J f LL <br /> • Pleaso print or typo Form de.legnod for Lisa on elde f 12 rch filar Sea Instructions on 6Qtk of Q e 6. <br /> P' f 4Paw p � Daportrnant of Toxic Substances Control <br /> Socramenro CollFornto <br /> UNIFORM HAZARDOUS 1 Generator s US EPA tU No MontfastDc.wmant No 2 Pago 1 InFormol,0n In the ehadad afoot <br /> WASTE MANIFEST � / � � � � of 1 e Hat required by Fsderat low <br /> 3 Generale,,,Noma and Mailin0 Addras. ` �r � 1 <br /> ASS g�G r��'; . C-01f'?0✓e-V aH <br /> 1lcrs `� X1,1 <br /> �dt• 5...>�.. 3I�? � <br /> ^ d Garorabr s Phone j j/Q 1 Lr� CI L"I <br /> �3�I- <br /> 5 iran:porlat 1 Company Nama 6 US FPA ID Nutnbar <br /> CD <br /> o ECOLOGY CONTROL INDUSTRIES <br /> _� C 17 & <br /> 5 39 <br /> 7 ansportor 2 Company Nome B US F PA ID Number <br /> Dee 91alod Fcc,l,ty Noma and-'-Ie Addras: <br /> 00 z ERICKSON INC 10 US EPA Number - rat , iyre rr te'XAMW <br /> ae 255 PARR BLVD <br /> 01 <br /> RlCHMONDr CA 94807 ' ,tell' <br /> Phoria <br /> I`� 3' 193 <br /> Q11 US DOT Deseriplion Ijrelud}np Proper Sh pp'np Name hazard Class and ID Numb.0 12 CanlalHors13 TO 14 Unit I t <br /> WASTE EMPTY STORAGECO TANK No T a Quanlil wl,val 1 Number <br /> sl°''" 512 <br /> GNon-RCRA hazardous waste Solid o1 1 TP I I P EPA/Other <br /> 0 N b DONE <br /> m E Stale <br /> A I I I EPAJollrar <br /> o T ` <br /> m l R i I I ,Iota <br /> 51 d I I t I � EP,q/Qlhor <br /> Slate <br /> rL jl I <br /> V <br /> ts-r I I I I EPA/Olfser <br /> y <br /> 1 Addhitlnal Desertpllogs for Molartdls l�letod Ahova , <br /> r k Htihd69 Ccdas For Was,es Eh Fad Alye�e <br /> rn <br /> QTY— - �"EMPTY STORAGE F t � y'� a �� b <br /> -------------- <br /> I tl= ]Ytl JMTH <br /> z 15 LES DRY ICE PER 1000 GALLON$�d'�!, 4 N ` <br /> Lr r„;� �.r s x <br /> �111earlapprop iatenprotectivellcioth+ng when handling, SITE LOCATION: <br /> Z 24 Hour Emergency Telephone Number: <br /> zl 24 Hour Emergency Contact: <br /> ERG 171 <br /> 16 GENEkATOR S CERTIFICATION I harab doclarc Ileal the onrents of lhI 'j <br /> f marlr0d and labeled an y C e eons nmanl ore fully an <br /> }� Y d oeeurasolli desenbed obo�o b)r proper Shlaping Home and aro t, rj lad packed <br /> d are m elf re•pacra In proper condiLan for Transport by hlgh�a7r according to applicable�nkrnollonaf and na}lonal gevarnmonr ragufonons <br /> Hd I If 1 am o large quanlllyy gcnarotor t corlifr Il+or I have a program n place to raduca rho.plume and rcxiclty of~0510 gancratod to the deorea I he-el delo•mined Io b;-conamtea'Ir <br /> pracl icobia and That I haeme eeleclad the proetleabla method of irealment storage, or d'spoaal eurrrcntly ovailabfe to me.,hleh m rin'11 s 11,a present and Fulurc 1hi`00 la hun%an haellh <br /> fx end Tho CA-lronmanl OR 1 am a sm011 goannly geri&rator I koro moria a good;01111 offort mint mr Wa la ger'eranon and clod Iha boll.a.rc monogemont merho�that is <br /> d 0-odable to mo and that r n afford <br /> Prinl Nom 51® <br /> M nrli_ payor <br /> (7 <br /> w t <br /> r .fit U f r 17 ans oder 1 AclrnoW tori nmenr of R9e81 t eE Morehals Gf - <br /> n <br /> „ P led/-Typed Nome S1 <br /> 8 Month pa ear <br /> v <br /> LL Q 19 Trans crier 2 Acknorlod emenl of Rece1 to Matcrigl9 I <br /> TPrinlad/Typed Name Slgnoture Month Dox Year I <br /> E <br /> uQa R <br /> V <br /> 19 Dl,erepancy 14dreatlan Space I <br /> 1 20 F ellil Owrter at Ci gralor:erl,kccoor,of rata{ F of hoaardou matarials cover this montfost e.c vs Holed in Ilam 1 IPri 1 d/T7pod Noma 1I 5lgndt <br /> Monik l�Day 9raor <br /> I <br /> I 4 <br /> DO NOT R E BELO T AE <br /> DISC 00— (a/97) <br /> EPA 97700-- %Vhhl TSDF- SENDS THIS COPY TO DISC WIT}ilN 30 DAYS <br /> i2 In P Q Bax :COO Sacrornento CA 95812 <br /> QT d bEb ON Ia3 WdT2 S 666T 6 adW <br />