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s <br /> —"I State.of Califomla—Environmental ProteNwn Agency R" <br /> dorm Apploved OMB Nb 2050-0039(Expires 9.30-96) See I115truitions t ck Of Hage.6 Deportment of Toxic SUbstances Control <br /> 'Please,print or type. - Form designed for use on ate(12-pikh)typewriter. - - -.Sacramento,,Calrfomrd. ,.:£- <br /> UNIFORM HAZARDOUS 1. Generators US EPA ID No. . Manifest Document No. 2. Page 1 Information in the'sladed areas <br /> is not required by Federal law. <br /> r WASTE MANIFEST of <br /> 1 63$751 <br /> 3. Generators Name and Mailing Address <br /> 1944 LA. 0- �I UAL D. , S 0-11c,WA CA 9S.) <br /> WA. Generators Phone R <br /> GS. Transporter 1 Company Name 6. US EPA ID Number <br /> OP <br /> Cf ;c <br /> o 6 <br /> J 7. Transporter 2 Company Name 7 S. US EPA ID Number <br /> 00U <br /> z9_ Designated Facility Name and Site Address. 10. US EPA ID Number <br /> `= Erickson jnc. <br /> (, 0 255 Parr Blvd. <br /> J <br /> Ric woad,CA. 94601 w JA 0 10 19 14 16 16 - 9 2 <br /> - Z 11. US DOT Description(including Proper'Shipping Name,Hazard Class,and ID Number) 12- Containers 13. Total 14. Unit <br /> P _ No. Type Quantity Wt/Vol <br /> 14CM--RCA iia za rl—A.,. Waz to Sol irk-.-- . <br /> 3 G <br /> N E Waste Ew-+-y Stc iraga;. Tank, T Q <br /> F Isle <br /> 0000 N b, <br /> 4 E <br /> :} v R <br /> J o A <br /> :.a T C. <br /> ODO <br /> LU <br /> Z d. <br /> W <br /> U <br /> W <br /> - 4 <br /> W <br /> J <br /> a <br /> - O 15. Special Handling Instructions and Additional Information <br /> P: ci:av f1"on source-s- of i{#-I.itim,. ,always Fear liaidliat.s when ix�r incr around <br /> Z 11,G.S,T. r� 24 Hr, Ccc itact. .4,a�-�aRS Lc� ra2.I'�l.(.xl� _/ <br /> LU <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper.'hipping name and are classified, <br /> U packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations, <br /> } 1 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 determined to be <br /> J <br /> CL economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> U) threat to human health and the environment;OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> - aG waste management method that is available to me and that I can afford. <br /> O Printed/Typed Name Signature i I^` Month Day Year <br /> ! +w..r <br /> Z R 17, Transporter 1 Acknowledgement of Receipt of Materials <br /> LLJ(� it Printed/Typed Name Signature J ) t lM�omlk Day Year <br /> W0 18. Trans orter 2 Acknowled ement of Receipt of Materials j <br /> u- T Printed/Typed Nortre Signature Month Day Year <br /> -i O E <br /> R <br /> U) 19. Discrepancy Indication Space <br /> F <br /> A <br /> ZC <br /> _ l <br /> L <br /> l 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> `.Y T Printed/Typed Name Signature Month Day Year <br /> l <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/95) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />