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Wiea3e print or type (Form deerpnad(or use on eirle er7 pitch)typawri far, Form Apism~ OA49 No 1050-0039 Crplrea OL30dA <br /> UNIFORM HAZARDOUS 1 Generators US EPA ID Nd Manlfe 1 2 Page 1 Information m the shaded arena <br /> WASTE MANIFEST C n 9 $ 1 14 lk3 5 0 2 Doc�lm n N 8 of 1 la not raqulred by 1=ederaf law <br /> Generator s Name and Marling Address U A btaN IMartNeatt Document Nuterbel <br />• Wickland P1:operties (Regal 604 ) <br /> P.O. Box 1 3648 , Sacramento, CA 95853-4648 B sire 0a+enws Ito <br /> 4 Generators Phone( 916 I 921 _I 10Q (24 houZs ) HYH03601341 <br /> 5 Transporter 1 Company Name 6 US EPA 1D Number C Stale Tans era 10 <br /> Excel Tx ans I CA j D6 18 P I 9t89t8l 2 6 D Trans era Phone <br /> 7 Transporter 2 Company Name $ US EPA ID Number E State Trenspon*es IO <br /> I I I F Tran er=a Phone <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number Q State Faculty s 10 <br /> Cameaon-Yakima, Inc. WAD009477175 <br /> 1414 S. First Street H FactRtys Phone <br /> Yakima , [dA 98901I WAD P 10 1914 7 11 17 151 (509) 452-6605 <br /> 71 US DOT Description (Including Proper S111 g 12 Contamers of 14 l <br /> ( g p pprn Name Hazard Class and 1Q Number) Total Unit <br /> 1 No Type Quantity tivol Waste No <br /> G a <br /> E Hazardous Waste Solid <br /> " N.O.S. ORME NA 9198 EPA <br /> E 0 11 P D N 0 1 10 10 P W002 <br /> R p <br /> T State <br /> 0 I 352 <br /> d <br /> C�71 O`7 }fit" <br /> J Add IIlonal Deacriptlons for Materlak, Usted Above Spent Carron canisters K Handilirty Codes for Watewe LWUd Above <br /> I used for vapor txtraction wells contaminated with <br /> unleaded fuels . <br /> 1�mergency contact. George Converse (916) 668--5300 <br /> Acceptance #10-286-9 <br /> 15 Special Handling Instructions and Additional Information <br /> Standard foz petroleum range hydrocarbons C lo— BS <br /> 16 GENERATOR S CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping <br /> name and are classified packed marked and labeled and are in all respects in proper condition lot transport by highway according to applicable <br /> international and nationai government regulations <br /> If 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 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 /> PnntedfTyped Name Agent for Wickland $lgn a Month Qay Year <br /> George L. Converse � <br /> T <br /> 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> A PnntedlTyped e ., Signatdfe h Dar Year <br /> S 2� D/C/ l c� l <br /> P <br /> o t8 Transporter 2 Acknowledgement of Receipt of Materials <br /> R <br /> T <br /> PrinledlTyped Name <br /> E Signature Month Day Year <br /> R <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> c <br /> 1 <br /> L <br />. 1 <br /> T 20 'ac+Irty Owner or Operator Certification of receipt o1 hazardous materials covered by this manifest except as noted in item 19 <br /> PrintedlTyped Name <br /> t Y Signature Month Day Year <br /> 4.74L_ 0/ / I7 <br /> EPA Farm 8700 22 (Rev 9 86) Previous etiorons are obsolete Reorder No BW Lab Safety Supply Co <br /> ORIGINAL-RETURN TO GENERATOR <br />