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Form Appro.ad OMR No 2050-0039 ;,36,991 <br /> PI•a,e prem or lypa s' lL><se oSee Instructions on back of page b. 8 0-S-76 <br />� arm de,lgrred fey use an eflte/12 ptlehf ryperntarDeportment of Toile svbatanrns Cnnkol <br /> Saeramanle Cohfernla <br /> LINA ORM HAZARDOUS1 Generoior s US EPA ID No 1 ret 2 Page 1 Information In[he shaded areas <br /> WASTE MANIFEST / is no wyvireal 6y federal la- <br /> 3 Gena bra Na. A f41 <br /> el rya Add raes �y�r('l °f <br /> h a VP-6- Rte�q-70 <br /> R Generator s phone 5� Gin�� az 517 2 33 <br /> r`r 5 Transporter 1 Company a e <br /> co co 6 US EPA tO Number <br /> c ECOLOGY CONTROL INDUSTRIES PIAI P 2 013 0 173 <br /> T 7 Transporter 2 Company Nama <br /> t7 US EPA ID Number <br /> d <br /> U 9 Deslgnolad Faelhy Name and Soo nddraas <br /> a 10 US EPa)D Number <br /> ERICKSON INC. <br /> 255 PARR BLVD <br /> RICHMOND, CA 94807 946 6 3 9 ; <br />�.U 11 US DOT Doscriptlon(including Prepar Shipping Name Hazard CIOs, and ID Number) 12 Conlainer3 13 Total TA Unit <br /> = No T a Quantity Wt Vol <br /> z WASTE EMPTY STORAGE TANK P,W- 5� <br />:o k Non-RCRA hazardous waste solid p v Q j Q P <br /> m ata <br /> R <br /> er T <br /> g � l'dyC'I <br /> a� O <br /> R <br /> EP r , <br /> LU d <br /> M <br /> 6LJ 51a 1 t <br /> r <br /> u+ FP <br /> a ' <br /> rel <br /> LU <br /> i <br /> Q <br /> d15 Speclet Hohdlln I structlons a d A ,conal f fo flan <br /> >~ Wear approwr'a�e pro ec ve 61fiWAIn when handling, SITE LOCATION <br /> z 24 Hour Emergency Telephone Number,/'-?ft- x,343 <br /> 24 Hour Emergency Contact: L,. �{rr ERG#' 171 <br /> Q16 GENERATOR'S CERTIFICATION I hereby declare Pkat the contents of this conslgnment are fully and accurately descrl6•d above by propar shlpPrhg name and aro elossrfled packed <br /> V <br /> marked and labeled and ore m all respects In proper condition for Transport by hlg6-ay according to applledblo wernahonal and national government reguloilaro <br /> —i <br /> yr if 1 am a large gvanNy generaror I eernfy that I have o program in place fo reduce The volume and taii[ry o)waste genartsted l0 1M degroe I have duermmad to be aoonemrcally <br /> proolca6w and thin I ha.a 5efeeted Tho prachca6le merhod aF troalMord siarade,or dispose!currenlfy a+rollabla to v whldr ied to the Iha peenI hmf and future morsel b human haeUh <br /> 0 and rhe enr,me and <br /> of If I am a,enol(quonhy generator t have mads a good Fodh effort to M1nlm,ze my wa_10 genarahon and soleCT Ae belt waste management method that is <br /> 0 0�ollohla to me and That l can afford <br /> Pre led/Typed Ndma Signature <br /> �f Month_ lOay Teo <br /> LV 1 <br /> RI 17 T rrer 1 Acknow lad emenr of Rece, t of Matendis <br /> Pew /Ty Name <br /> LUSrgnat re one <br /> � ear <br /> O 0i 18 Trans oder 2 Acknowled ement of Reeel t of Materials I <br /> F <br /> Prinred/Typed Name <br /> w SfgnaIwo Month Day Year <br /> Q R <br /> V f 19 Discrepancy tnd canon Space <br /> z A <br /> C <br /> I I <br /> L <br /> 1 20 Facli, Owner air O grata. <br /> Ceritflcallan of reroI +of hazardous motenole soared by th s mamfast secs I as noted in Item 19 <br /> P"nls; o Nama S,gnoru <br /> �r%%r//�� <br /> A- M14on Oay Yef �' ar <br /> l q 4 $ I <br /> DO NOT WRITE BELOW THIS LINE <br /> 0 (4/971 <br /> EPA 877000— Who. TSDF SENDS THIS COPY TO 0T5C WITHIN 30 DAYS <br /> EPA 22 To P O Box 3000, Sacramento, CA 96912 <br /> i <br /> bc6 ON I03 Wd22 S 666T 6 6OW -- <br />