Laserfiche WebLink
Co . <br /> State of prove mio <br /> Form Ap -{nwronnAnfal protxtion Agency <br /> nt MB t:o.2050-0039(E.pires 9-30-94) See Instructions on back of pag Department o4 Toxic Substances Control <br /> Please print 0o, pr <br /> tY'Pe. � Form d.ugrr.d(or use on elite(12pirch)lypewn. <br /> Sacramento,California <br /> 1. C <br /> enerator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UdVI .0 M HAZARDOUS <br /> WASTE MANIFEST r is not required by Federal law. <br /> D 3 1.� 1 !4' S of <br /> 3. GeMrotor's Name and Mailing Address SHELL OIL COMPANY A. State Manifest Document Number,;�v"' <br /> HAZARDOUS WASTE DEPT. <br /> .0. BOX 4848 B. StateGenerator's ID y t� <br /> 0 4. Generator's Phone `�t -%? . 0 r � <br /> (7140 Sc 1 INAHEI11, CA �2bQ H Y' H d 3'-16*11. 0 1 7 7 W � <br /> FFons rtgr 1 Comp Name 6. U$ A I Number a <br /> ff ( 4 C. state Tramporters ID: r,�I �` ) e <br /> D. Transporters..Rhone <br /> to <br /> t7. Transporter 2 Compnny Name 8. US EPA ID Number E. State Transporter s ID - <br /> F. Transporter's Phone <br /> I <br /> i 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> X55 P0!"R gi__�r'i'� '� r, D '0 it '-F L - '_7 - H. Facility's Phone - 510-2-25-1393 <br /> i <br /> T` i -2-25-1393 <br /> 11. US DOT Description(including Proper Shipping Name, Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> No. Ty Quantity Wt/Vol 1::Waste Number <br /> `State <br /> LT, ,7 n EPA/Other <br /> E ; - -c^, <br /> N b. State <br /> E <br /> R EPA/Other <br /> A <br /> T �� <br /> T State <br /> R EPA/Other <br /> d. <br /> State <br /> EPA/Other <br /> J.,Additional Descriptions for Materials Listed Above " K. Handling Codes for Wastes Listed Above " <br /> a:EMPTY TANKS) AND FIBERGLASSISTEEL PIPE a b <br /> c. d. <br /> 15. Special Handling Instructions and Additional Information rlC L T <br /> AV011D CO�STAC'T (41TH SKIN/'EYES cr STC�TIOr�ai <br /> VICE : <br /> 24 HOUR EME.REE"ICY >,i._-ji'E. NUMPER (800.) /+�4— R <br /> 31.G 15 WAT;=;LL00 ole,(!D <br /> S-7T0 K N' rre�nr� rbc'0 <br /> l:_ {u. � it A. ,..i t-JJ <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 /> threat to human health and the environment; OR, if I am g small quarifity generator, I have r.-ode a good fc;ti; effort to min;mize :: -ante generaticn and se!ec'the b <br /> waste management memod that is available to me and that I can afford. .,r <br /> P' ed/Typed Name Sign re tyt DEH,�L.f`vi Month Day Year <br /> - , <br /> /J vN��� f_ ca. / U S <br /> T 17. Transporter 1 Acknowledgement of Recei t of Materials ^1 <br /> R <br /> A Pr Typed N me Signa / -�� Month Day Year <br /> " l�l,/I�, , � C L � 0 <br /> 5 <br /> 0 <br /> 0 18. Transporter 2 Ackthowledgement of Recei t of Materials <br /> T Printed/Typed Name <br /> E Signature Month Day Year <br /> R <br /> I <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> L <br /> 1 20. FacilityOwner or Operator Certification of recei t of hazardous materials covered b this manifest exce t as noted in Item 19. <br /> YPrinted/Typed Name Signature Month Day Year <br /> z;47` �f8t4+ 9?L .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 />