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tt w _i <br /> Agency See Instructions on back of page f Department of Toxic Substances Control <br /> toll W <br /> a .?nyp-Q039(Eapnn 9-30-94) <br /> tM rw or sem. Fermi d..I for aw on lite(12-pitch)typewriter. Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST In t / r lo lo 3 13, 2 1 1 r 4 of 1 <br /> 3. t„rw cnar's Nam.and Mailing Address SHELL OIL COMPANY A. State Manifest Document Number <br /> HAZARDOUS WASTE DEPT. '9 2 Q 4 4 16 <br /> P. O. BOX 4848 B. State Generators ID <br /> 4. Generator's Phone10 11 1717 <br /> ransporter 1 Comfy Name 6. US EPA ID Number C. State Transporters ID <br /> L— iLt�k>--N _ S-r( �, 9 1 0(0 `1 i 30 <br /> D. Tronsporters,PltQrq C <br /> Y 8. US EPA ID Numbers �f`j /O <br /> 7. Transporter 2 Company Name E. State Tramporfer's ID <br /> F. Transporter's Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> ERICKSON, INC- <br /> t� '�A�?R BLVE 1? �f �. F, v > H. Facility's Phone 510-2 <br /> 35-1.39.3 <br /> Tr LS �G t <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 I. Waste Number <br /> �;F,L%-�nL:.Jvve nil,;-.r, �,�iU, Y Stoll <br /> f <br /> v — <br /> E0 10 1, 7 0 '� Ie PEPA/Other <br /> J b. <br /> State <br />-E <br /> Q EPA/Other <br /> T C. <br /> Stafe <br /> EPA/Other <br /> d. Stole <br /> EPA/Otter <br /> J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes listed Above <br /> a;EMPTY TANK(S) AND FIBERGLASS/STEEL PIPE b. <br /> 1SL 35 <br /> c. d. <br /> 15. Special Handling Instructions and Additional Information <br /> FACILITY: <br /> AVOID CONTACT WITH SKIN/EYES SERVICE STATION <br /> f HOUR FMERG NCY PHONE NUMBER (800) 431u WATERLOO ROAD <br /> STD'--'K-1 DN, CA. ?5,'_0,5, <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 envi.onrI OP. if ; ars a <, all aaanti^: generator, I t.,,,e mage a g.nod fait", affcr to minimize my •oste aer.eration and elect the best <br /> waste management method that is available to me and that I can afford. <br /> rated/Typed Name Si Lure O t-i4 t � Month Year-71 <br /> w <br /> 1 �N L3�r,f;._F L:F ^� ''\\ter <br /> SH='LL i1IL CEJ. / V <br /> 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> Printed/Typed Name Sr xrKF ., MonthUDay -7 ear <br /> 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> Printed/Typed Name Signature Month Day Year <br /> 19. Discrepancy Indication Space <br /> 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Printed/Typed Name Signature Month Day Year , <br /> __] <br /> LILt Lt1JL4C.Jdtf'TJ95L ,SG DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br /> 8022A (12/91) <br /> To: P.O. Box 400, Sacramento, CA 95812-0400 <br /> 700-22 ' <br /> ) <br />