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V7:� B N 9(E p 9-3&94) See Instructwns an back of page 6. D.pa,�..r d T.sr�.�re..carool <br /> rt <br /> h'pe Form d..q.re Ip rine en.ir►(lTprsrlrl ypawnrer Soryasewrb,caTifoara <br /> 1 Generator's US EPA ID No Manifest Document No 2 Pope I ht(orerdie.n dw shaded areas <br /> UNIFORM HAZARDOUS is na��by Fada.al lo <br /> WASTE MANIFEST r A g 8 5 4 5 0 3 3 B 3 of <br /> 6i <br /> Gsiierata,'.Name and Moth"Address SHELL OIL COMPANY <br /> I Aznnous wnSTE DEPT. <br />' P. O. BOX +BAS _ - <br /> 4 Genermor,t Mane (7 4 )5210-3316.' I %!803 <br /> 5 Transporter 1 Com Name b U A ID Number C'.StaseST <br /> a TG �u Ca�� fn GIS j 1 �,•s w <br /> ti <br /> 7 Transporter 2 Company Name 8 US EPA ID Number <br /> F�T <br /> 9 Des,gnoted Facility Name and Site Address 10 US EPA ID Number G <br /> CT PQ a Qi Tn rr% -1r0l'A Ll I I <br /> pion(. par Shipping Nome Hazard Class and ID Number) 12 Comamen <br /> i 1 US DOT Dean nduding Pro Shr 13 Total 14 11tsf <br /> No TV Qu Wt/Val 111111 <br /> �N19q-r. T <br /> b <br /> c <br /> e <br /> d <br /> 170ewlf#tone for*RaNgq faWV AWR rt <br /> Elk �t �f"-'f. r.1 '��t i tCa'�yC+J� rl ''C•i1:� <br /> 5 Special Handling Imtnuchans and Additional Information 1 A,C I L:-r" <br /> ,/CID CONTACT WITu EVE—SIS-,INc:'RVICE • <br /> ei Hri ip EMERSENCY "`f�'1t`,E `:I_ML1E..R (B'O'LA) ,E/4-3,:00 i 3i5 '4'-11= L0Q ROAD � <br /> !F-'1WIPLE PLAcnRIr, Y.F IJN1993 PROFILE it 017425 STCIOV70N. CA. 952015 � <br /> 6 GENERATOR'S CERTIFICATION I hereby declare that the comarrh of the consignment are fully and accurately described above by Proper shipping name aid aro ckzssrhed <br /> pocked marked and labeled and are in all respects in proper condmon for tromport by highway according to applicable federal state and international kzws <br /> If I am a large quamity generator I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have deMrmwwd to be <br /> economically practicable and that I have selected the practicable method of treatment storage or disposal currentfy available to me which moumizes the present and future <br /> threat to human health and the environment OR if I am a small quarry generator I have made a good faith effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that I can afford <br /> rated/Typed Name Sig i]„ $ Hr7LF D Month Day Year <br /> P t f E rt 5"EL!_ OIL CO. 7 <br /> Tronsporw 1 Acknowledgement of Recn t of Materials <br /> t=jjVTyp*d Nameg <br /> Sig <br /> re S Day <br /> �' p �� Month �Year <br /> Wr <br /> 8 Trans r 2 Acknowled mem of Ricer t m Maenah <br /> rated/Typed No Signature month Day Year <br /> Discrepancy Indication Space <br /> 1 <br /> d Owner or O rrnar Ccatian of recei t of hazardous matenals covered b this manifest exce t as noted in Item 19 " <br /> yped Name Signature <br /> Month Day Ysor , <br /> DO NOT WRITE BELOW THIS LINE. <br /> 81ve GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br /> 412/911 To P O Box 400 Sacramento CA 95812.0400 <br /> 2 <br />