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tote of California— nvironmentol Protection Agency <br /> orm Approved CNB No.2050-0039(Expires 9-30-94) $@@ Instructions on back of page Deportment of Toxic Substances Control <br /> lease print or type Farm designed for use on elite(12-pitch)typewriter. <br /> Sacramento,California � <br /> UNIFORM HAZARDOUS l. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST C P n _, [l. oj o of <br /> 3 Generator's Name and Mailing Address SHELL 0 TA.COMPANYA. State Manifest Document Number <br /> H6'Iznnous WnSTE DEPT. 9 044"`19 <br /> P. O. BOX 41_'•48 B. State Generators ID <br /> _ _ <br /> 4. Generator's Phone (?i(!,) 5 20 i C. f,NI:IC 11, ''f1, <br /> N 1Y H (23 16 10 1119 1 7,7 <br /> 5 TWnjD r, r I Comppnx Nome 6. US EPA N+(T r ) c� C. State Transporters ID <br /> D. Transporter' <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. StateTransporter's ID <br /> F. Transporter's one <br /> FIC <br /> d Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> tiLt. . Ll B 0 0 ffi H. Facility's Phone ? ? <br /> 510 39.E <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> No. T Quantity Wt/Vol 1. Warta Number <br /> _State G - <br /> C' t! 1D1 P 0 8 0 0 ,1 F :EPA/Other <br /> E <br /> N b. crte <br /> E <br /> R EPA/Other <br /> A <br /> T C. State <br /> O r <br /> R EPA/Other <br /> d. State <br /> EPA/Other <br /> J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes listed Above <br /> a:EMPTY TANK(S) AND FIBERGLASS/STEEL PIPE a: <br /> "Task-� 15033 <br /> C. d, <br /> 15. Special Handling Instructions and Additional Information CPC T I T j V <br /> A V07ID I'CNTAC T idITH 5K N/EYEti SERVICE STATI&Q <br /> '-OUR EMERGENCY ?HONE NUMBER E`20 431- WATERLOO ROM <br /> STOCK T LSI'.. Cf;. `35"'t'IC <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <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 determined to be <br /> 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 /> 'h:eat!�Su:nar heat` u,� ;;,e environrnani; '.DR, if am a small quantity generator, I have made a good ioi,in effort to minimize my waste generation and select the best <br /> waste mono ement method that is available to me and that I can afford. <br /> Printed/Typed Naje Si LJ'N SEHF}1 <br /> I _ 9 re ,. f ❑;' Month Day Year <br /> SHELL 01 L- GG / <br /> T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> N Pri /Ty ed Name Signa Month Day Year <br /> P 10 17 jc7 <br /> 0 18. Transporter 2 Acknowciciernent of Receipt of Materials <br /> t Printed/Typed Name <br /> E <br /> Signature Month Day Year <br /> R <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name r <br /> re <br /> Y <br /> Month Day Year <br /> ill+;5 .4 -804+-,11)81 JG DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> 8022A (12/91) To: P.O. Box 400, Sacramento, CA 95812-0400 <br /> 8700—.22 <br />