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Pteasiai print or type (Form designed for use on elite(12 pitch)typewmer) Form Approved OMB No 21150-0039 Expires 9 30 88 <br /> UNIFORM HAZARDOUS 1 Generators US EPA ID No Do an f t 2 of 1 isinort aequiredtby Federalaaws <br /> WASTE MANIFEST ICI D 8 14 1 8 5 G Z `!�""p V <br /> 3 Generators Name and Mailing Address r A State Manifest Document Number <br /> WICKLAND FROPETIES (regal 644 ) , `4734S " <br /> P. ©. BOX 13648 , Sacramento , CA 95853-4648 B State Generators ID ' '-tis .` <br /> i36Qt34 - � �M � <br /> 4 Generators Phone( 9 16 ) 921-1100 (24 hours ) HlQ <br /> 5 Transporter 1 Company Name 6 US EPA ID Number C State Transpo►ter't3 ID <br /> D Trans � Ph f 1 <br /> I <br /> 7 Transporter 2 Company Name 8 US EPA ID Number E State Transporter's ID <br /> I I F Transporter is Phone <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number G State Facility's ID w s <br /> Cameron-Yaikilaa , Inc. <br /> 1414 S. First Street H Faculty's Phone <br /> WA 919!g6i wIA p it 9 4 7 'k 5 4 093 452-6605 <br /> 12 Containers 13 14 <br /> 11 US DOT Description (Including Proper Shipping Name Hazard Class, and 10 Number) No Type Quanal tity lty nit Waste No <br /> G a S 4 <br /> Hazardous Waste SO2.id <br /> IN <br /> E 1Q.D..S« ORHE NA 9198 -Q 1,0 5 5 Ri � 1 � '+� _ 1) U002 <br /> A b -_ Stat* <br /> T (452 ' <br /> 0 <br /> R <br /> C � <br /> dF <br /> ru <br /> � r ' <br /> 4'-Additional Descriptions for Materials Listed Above K Handling Codes for Wastes Listed Above <br /> Spout carbon oanLatfara use"or vapor 0xtr&Ctio <br /> _ Vith."U"ieaedt fuel. w w <br /> �"Effie_llxoucy' contact: ' George Ct��►voine !9!5� G5�--5 8S <br /> 15 Special Handling Instructions and Additional lnformation <br /> Stabda rd for petzolevW range hy&-oc4rb=a <br /> 16 GENERATORS CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shippino <br /> name and are classified packed, marked and labeled and are in all respects in proper condition for transport by oighway according to applicable <br /> international and national government regulations <br /> If I am a large quantity generator I certify that t have a program in place to reduce the volume and toxicity of waste generated to the degree I have <br /> determined to be economically practicable and that I have selected the practicable method of treatment storage or disposal currently available to <br /> me which minimizes the present and future threat to human health and the environment OR if I am a small quantity generator I have made a good <br /> faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford <br /> PnntedlTyped Name Signature Month Day Year <br /> Agent for W=k-Land nd <br /> T 17 Transporter 1 Ac nowtedgement of Receipt of Materials <br /> R <br /> A PrinledrTyped Name / Signature Month Day Year <br /> P <br /> 0 18 Tra orter 2 Acknowledgement of Receipt of Materials <br /> R <br /> T Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I i <br /> L <br /> 1 20 Facility Owner or operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19 <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> EPA Form 8700 22 (Rev 9 86) Previous editions are obsolete Reorder No 860 Lab Safety Supply Co <br /> GENERATOR COPY <br />