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�c �,9-30- See Instructions on back of page b. DepaAmer of Taea shbslurses corral • <br /> 9 3avq <br /> y AM• Fele 1* is ler ow on eke(121h**)hp+wra r Saverrrlo CaiiOarta <br /> I Generator's US EPA ID No Mhsndest Documsrd No <br /> UNIFORM HAZARDOUS 2 Page i sot requi n the shaded r rw . <br /> WASTE MANIFEST r• P of is not � � <br /> t <br /> •Nom.and Mail"g Address SHELL OIL COMPANY � �• <br /> HAZARDOUS WASTE DEPT. <br /> P- 0- BOX 4848 <br /> I Generator's Phone t ) 3 — 71 92802 •;ir Tr <br /> r � 7 <br /> t �sparter I Comfy Name rb US FSA ID Number C. <br /> -�.��L� Inc 4+ a 9-�1 An q y y{ ,- O5 <br /> 7 Transporter 2 Company Name �f 8 US EPA ID Number E�i O <br /> t'ICKSON, <br /> Designated Facility Name and Sri@ Address 10 US EPA ID Number G_ 5r16 <br /> INC. <br /> PARR PLVD. F? D 0 0 5 4 S F, 3 2 -2H 1393 i <br /> 1 US DOT Deem non(including Proper Shr 12 Containers 13 Total 14 Un, <br /> P l mg Per PPm9 Name Hazard Class and ID Number) <br /> NO T Wt/vol L Waste hkhnhher, <br /> ,, Lr� .. ail,., ..�♦ ti s <br /> Stere Y� f <br /> � 13 <br /> Z T 7 0 I of P f�A/Other <br /> b <br /> Stale <br /> EPA/Other <br /> c _r <br /> Stave ti's r 0 <br /> roc <br /> EPA/Other <br /> Sh" <br /> �Y <br /> EPA/Other . <br /> DesotptmwforMatenok.l3sfadAbowsgT <br /> RAl `'t8}e �fi*s �T fL f.bfle oe INaesa tested Above <br /> � � <br /> est . FId <br /> � <br /> ,w S <br /> 5 Special Handling Fmtrvcnans and Addmonai Information F fC I .I TY <br /> JOID COIq;AC* WITH SKIM/EYES SERVICE STATION <br /> 'f HOUR EMERGENCY PHONE NUMBER (800) %24-9.300 4315 �,iATERLOO ROAD <br /> STOCKTON CA. 9=2215 <br />�5 GENERATOR'S CERTIFICATION I hereby declore that she consents of the consignment are fully and accurately clownbed abate by proper shhppesg none and ore classified <br /> packed marked and labeled and are in all respects in proper concidm for transport by highway according to applicable federal stare and international lows <br /> If I am a large quantdy generator I certify that I have a program in place to reduce the volume and toxhcrty of waste generated M the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment storage or disposal currentfy available to me which mmhrruzes the present and future <br /> threat to human health and the emnrdhrnenf OR If I an a small quarrhfy gene.-I r I hom mode a good faith effort to mrumhze my waste generation and select the best <br /> waste management method that is available to me and that I can afford <br /> ,1anted/Typed Name <br /> S+ roON PEH�3L OF Month boy Yeor i <br /> SHELL OIL CO. / 01 0 17 '9 14 <br /> Transporter I Acknowledgement of Receipt of MatenZ <br /> nted/TYped Name Ste Month Day Year <br /> ILJ �. J OL7 S IV <br /> 8 Transporter 2 Acknowlednemend of Recer of Materials <br /> rated/Typed Name Stgnature Month Day Year <br /> t <br /> Discrepancy Indication SPace <br /> i Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as pored in Item 19 <br /> yped Name Signature momhDry7-2Yede <br /> 475242804+3982 JG DO NOT WRITE BELOW THIS LINE <br /> 112911 Blue GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br /> 2 To P O Box 400 Sacramento CA 95812.0400 <br /> i <br />