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Oleise 9nnt or lype 1Form designed for ua•on*fele 1120frch)lyppwrrter) ForM Approved OMS No 2050-0039 Ernrrea¢30.98 <br /> UNIFORM HAZARDOUS 1 Generators US EPA ID No DocumenttNo 2 Paget islnot aequiredtion in tby he Federalhaded alaws <br /> ` WASTE MANIFEST D 1918 1 1 8 5 0 7 of Q <br /> 3 Generators Name and Mailing Address u J' <br /> Wickland Properties (Regal 604 ) x^� Illy <br /> P.O. Box 1 3648 , Sacramento , CA 95853-4648 &Stela <br /> 4 Generator s Phone{ <br /> 916 } 92 1 -110 0 (24 hours ) HYH 6 <br /> I <br /> I US EPA ID Number G states~ a}� <br /> 5 Transporter 1 om any Name <br /> 7C4 (24,&06H I I I f3 T tzar*Phone •• <br /> 7 Transporter 2 Company Names 8 US EPA Ip Number E State Trans on I <br /> 1 L F T rteeir <br /> 9 Designated aciiiiy Name and Svite Address 10 US EPA ID Number 0. ts <br /> State FaclikWe I <br /> s�af- II Faet11t1r'fe Phone <br /> A10,0 7 171 t5 1' .2 - 6Eds <br /> 12 Containers 13 14 I <br /> 11 US DOT Description (Including Proper Shipping Name Hazard Class and!D Number) Total Unit Waste No <br /> No Type Quantity tfVol <br /> E a Hazardous Waste Solid b EPA <br /> N N.O.S. ORME NA 9189 D M C' dCO2 <br /> E <br /> R b State <br /> 352 <br /> T 1 <br /> 0 <br /> R <br /> c - <br /> r. <br /> I <br /> d <br /> r� <br /> J Additional Descriptions tot•Materials Usted Above �` � w KHandling C:odwJos Wastes Listed Above <br /> Spent carbon canisters used for vapor extractiory wells <br /> contam=ated w3.th unleaded fuels. Emergency-con3�mct <br /> George Converse (916) 334-0162/(91f6) 668-53W (24, hours) «' <br /> Acceptance # 10-286-C + x� <br /> 15 Special Handling Instructions and Additional Information <br /> Standard for petroleum range hydrocarbons <br /> 16 GENERATORS CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately ldescribed above by proper shi cable <br /> name and are classified packed marked and labeled and are in all respects in proper condit,on for trans ort b ht hwa accordin to app <br /> international and national government regulations <br /> It I am a large quantity generator I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have <br /> determined to be economically practicable and that I have selected the practicable method of treatment storage or disposal currently available 10 <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 /> Printedrfyped Name agent for Wickland Sian e , ifontn Day Year <br /> George L. Converse t 1� "4214 r -( 0171012192 <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials ) <br /> R Month Day Year <br /> A PrmledlTypgd Name ` Signature <br /> N � f <br /> `/ L+- C 7 2 <br /> 5 V <br /> P <br /> 0 18 Tran ortef 2 Acknowledgement of Receipt of Materials <br /> R Month Day Year <br /> TnatuSi <br /> P ntedl7yped Name g <br /> R � _ ) / i <br /> 19 Discrepancy indication Space <br /> F <br /> A <br /> L <br /> I <br /> L <br /> 1 20 Facility Owner or Operator Certification of receipt of hazardous materials covered by this anifest except as rioted in Item ! <br /> . T Printed[Typed Name Signature / <br /> Month Day Year <br /> r� 1477 <br /> lei <br /> EPA Form 8700 22 tRev 9 861 Previous editions are obsolete Reorder No 860 Lab Safety Supply Co <br /> ORIGINAL-RETURN TO GENERATOR <br />