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State of Coliiorni—Enviro9 ! 7 !nmental Protection Agency See Instructions on back o; -)a a 6. -7�2-1 Department of Topic Substances Ccr-- <br /> corm Approved 0MR No.2C50-0039(Fxpires 9-30-991 <br /> ?lease print or type form designed for use on elite(12-pdc +riter. _ f Sacramento,Calilorma <br /> ..generator's US EPA 1D No. Manifest Document fir. 7, Page 1 informalion,n the shaded areos <br /> UNIFORM HAZARDOUS is not required by Federal]a-, <br /> WASTE MANIFEST I�} O p a l l 3 bl3 IS 3 1 3 1 7 of <br /> Af-$tale Manifest Document Nvmber <br /> 3. Generator's Name and mailing Address �� _ -- -. _ - <br /> �l -wFr <br /> X0.1-ML .` ' .;..;: :-_ <br /> 39 1'0 �}}. &rG.ti\ l.s�� . S. stare C*enerata;s LO - .. <br /> o -{rQcy, CA. 9537(0 <br /> d. Generator's P'r+one 17 <br /> -} <br /> 1 S/Op 4p <br /> 9 3b- <br /> �:I 5 Transporter 1 Company Name 6, US EEP"'A�ICD/Nfm�ber j( �j C. $foie Trgnsporter's!D . <br /> C11 <br /> /7 C!/ r/ / ��� D. Tronaporler's Phone <br /> P I t <br /> 7. Transporter 2 Company Name USE A tD Number E. State Transparler's lD <br /> - I <br /> F. Transporter's Phone <br /> I I <br /> 9 Designated Facility Name and Sire Address SO_ US EPA ID Number G. State Facility's ID <br /> � ! ERICKSON INC. <br /> z H. Facility's Phone <br /> c< 255 PARR BLVD I I I <br /> Inn n <br /> I 11 9 <br /> i_. C.,.toners 13. Total 1 d. Unrr <br /> < ll US DOT Description linclu0 23613 <br /> ding Proper Shipping Nome,Hazard Class,and 0 Number} Na. Type puanGly Wt/Vol 1. Waste Number <br /> Z I a, $late <br /> 3 G WASTE EMPTY STORAGE TANK EPA/Other <br /> sSo[idc,l/ vpr <br /> E rNon-RCState <br /> �I N 6. <br /> co; E EPA/Other <br /> �I R <br /> V <br /> A i State <br /> d i i EPA/Other <br /> y Stare <br /> I I EPA/Ocher <br /> ! J. Additional Descriptions For Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> o. b- <br /> I ! QTY. _EMPTY STORAGE TANK(S)# �✓�!d 139 <br /> TANK(S)HAVE BEEN INERTED WITH ` d <br /> 15 Spenal Handling Instructions and Additional Informat�an `lQ 1Lt�� j.y�r}" �.�' <br /> Wear appropriate protective clothing when han lin . SITE LOCATION: <br /> 24 Hour Emergency Telephone Numb : <br /> _24 Ho n . <br /> J I 16 GENERATOR'S CERTIFICATION: I hereby declare r'nat the cortents t consignment are fully d occurcW described above S o h, to name and are closs,hed, need, <br /> y y proper s pp, g p <br /> < marked,and labeled,and ore in all respects.n proper cardilia or rr InsporT by highway cc rding to apphcab!e internatloncl and ncsrionol government reguloCons <br /> If I am a large quann:y generator, I terrify that I hove a program in place to reduce the volume old torlcJy of waste generored to the degree! have detnrmined to be econom, Av <br /> J prcc5_a ble crd;�^^ 'save se!eC.d ^act-,ccti!.a o+>rec:m=_nt•Stora-^-.r r?apesal currently,:.nilnbl=1,,ne which m.m �P<t}re present and future threw ra human health <br /> `n and r'ne environment'OR, if 1 om a small quantity generctor.I have made o_ocd faith elfoo to minimize my wosre generanan and select the best v oste management method that is <br /> 0 ovdilable to me and thw I can afford <br /> P.,nted/T ped Name Signa:� ,/J �� Month pay Year <br /> w ! <br /> 17 Transporter I Acknowledgement of Recel :of Ma-erials <br /> Warinted/Typed Name Signa'_e Mon'h Day Yea, <br /> 0 =3. Transoorser 2 Acknawledaement of R,�ccia+of Care Aa!s / <br /> �' �. orr•red Typed Name Signal•-. j n',anth Day Yec- <br /> < <br /> 'Discrepancy indication Space <br /> 'r <br /> - A <br /> C <br /> I <br /> L <br /> 2J FaciEiry Owner ar Oaerc Certii,cot,on of rete;cr al'^acjrdovs m,cr=_rials comae- '­t.-, e< en'es na'ea.n irw„ 19 <br /> Tr d!Tvped Name Sig pan..- 7vtonth Day ye_, <br /> y 60 X 081 i Z� R- P <br /> DO NOT WRITE BELOW THIS LINE. <br /> ,-i, <br />