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i C Oma—Envrv+wwAai PrMectwn Agency 1 <br /> nrewd OM6 No 2050-0039 Mxpww 9 36-94) See Instructions on back of page 6. Departiesrnr Tine Subitatsree Patwd ' <br /> Me or"Pe forest despned for use on aZre(12pdrh)Iype.Ynrx S C�� <br /> i Generotors US EPA ID No Manifest Doetnnarm Ne 2 Page 1 Ink.olran w the shaded aeae <br /> UNIFORM HAZARDOUS <br /> a not regrred by Federrd low <br /> WASTE MANIFEST r n o 8 If of <br /> Generator s Nome and Mailing Address SHELL OIL COMPANY <br /> HAZARDOUS WASTE DEPT. <br />' P. C. BOX 4848 <br /> 4 ii <br /> s Phare (-11 4)'5 50--3312' AN 1HE I M, CA 928032 <br /> 5 �I`C°"y�f 1°s"° 6 US EPA r z <br /> 7 Transporter 2 Company Name 8 US EPA 10 Number <br /> I9 Designated Foci*Name and Site Address 10 US EPA ID Number <br /> CRICKSON11 il"C. <br /> 255 PARR Sf_.P. G f J 0 0 4 8 6 U 9 a H '� <br /> T t1 F --I qiiA!Al <br /> I 1 US DOT Description(including Proper Shipping Name,Hazard Class and ID Number) 12 C wftia rs 13 Total 14 Unit <br /> � <br /> No T Lwt/Voi <br /> _ ,–a.tit, s <br /> C" 01 P080101i P <br /> b <br /> c <br /> t <br /> a <br /> d <br /> ftl�ty �� <br /> Joe <br /> iy`",�n�` <br /> sv.S'tX <br /> 15 Special Handling Instructions and Adddronal Information <br /> FRirILITY: <br /> AVOID r..r.NTgCT �JITH 15A !N/EYES SERVICE STATION <br /> + HCUR EfrTERGENCY nHONE NUMBEP (800) 4,i4—?300 4315 WATERLOO ROAD <br /> SSTOCKTON, GA. 95205 <br /> F 6 GENERATOR S CERTIFICATION I hereby declare that the contents of the cottstgnmenr am fully and accurately described above by proper shtppetg none and are classified <br /> packed marked and labeled and are in oil respects in proper condition for transport by highway according to applicable federal state and nitertwhonai Imes. <br /> If I am a large quanhty generator I certify that 1 hove a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment storage or disposal currently available to me whsdt minuntzes the present and future <br /> threat to human health and the environment OR if I am a small quantity generator I have made a good forth effort to memtge my waste generation and soled the best <br /> waste m emerm method that,s awifable to me end that I can afford <br /> anted Typed p ON BEHALF OF Moroh Day Year <br /> r �� SHELL CIL CO. c-) L� y" <br /> 17 Transporter 1 Ackrociveledgement of Recoot of Motenah <br /> Fvr7o/Typed Name _ ` S,gMordis Day <br /> `� 10 <br /> �, / /,Es G�I� --f�� / d 4J 7 year <br /> 18 Transporter 2 Ack dement of Race+ t of Marenah <br /> Printed/Typed Name Stgnahtm <br /> Month Day Year <br /> 9 Discrepancy Ind,catron Space <br /> oirty Owner or O orator Cerhftcohon of receipt of hazardous matenais covered by this manifest except as noted in Item 19 <br /> /Typed tgnature Month Day Year <br />�0475L42604+3982 JG DO NOT WRITE BELLOW THIS LINE <br /> Blue GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br /> (12/911 To P O Box 400 Sacramento CA 95812-0460 <br /> 122 <br />