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r " • 4o d Pee,eaioo Agcrcy See Instructions on bard 'f page 6. Dronr^^e^'of in"S"b"mnia c <br /> ,,1039(Eapi.es 9-]P91) Suromnno.Calilomw <br /> nn despned For use on eine(12NIK7Pe•+^er 2_ P 1 Inlonnation m the shaded areas <br /> 1. Gem atur's US EPA ID No. Manifest Dacument No. °ge is«t required by Federal law. - <br /> NIFORM HAZARDOUS / of <br /> i WASTE MANIFEST G 4 L.''IO 10 is 0 1 9 q 1 <br /> ], ('.er,eraror'E.Nome a,td Maifng.Pddress <br /> CrttivanAa USR, YaoDJ�rs Ca, ftv Ss 4-14tg <br /> tea• BoxSU09 <br /> N a qt5 3; 021M <br /> saw �awAl <br /> {. Garo/sib) 45 6 Nca2Fa1TV{�G <br /> 1✓r <br /> P?q <br /> 2 q.5 STOCYT fr <br /> I Com Nome 6. US EPA ID Number <br /> 'S. Tr«sporter Pant <br /> W egic LS d Pier +�C- C 14 D D 0 9 'i 3 q <br /> � 7. Transporter 2 C«aP°^Y Name <br /> 9. US EPA ID Number <br /> a <br /> u <br /> Q 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> Erickson,Inc. <br /> 255 Parr Blvd. 6 6 3 9 2 <br /> n Richn=)d Ca. 94801 <br /> .VU Iz. Corna;ners 11. Total lA. Unit <br /> II <br /> 11. US DOT Desafption&tcludirp Proper Shipping Nome,Harard Cl..,and ID Number) Na. T Ouaedny WIN. <br /> nZ <br /> Dx, °4laste-Fmpty Storage Tank. T P ,.P <br /> T3 G NpN-RCRP Hazardous Waste Solid. <br /> o E <br /> ao IN b' <br /> °DE <br /> n R <br /> V A <br /> o T a <br /> C? O <br /> R <br /> w <br /> Z d. . <br /> Z +.r <br /> w <br /> Z <br /> Z <br /> Q <br /> 6 <br /> N <br /> W <br /> C <br /> a <br /> Z 15. Special Handling Im&uaiaa and Additional kdormafian <br /> P Keep away from sources of_ignition. Always wear hardhats when Working around2 <br /> Z U.G.S.T. 's 24 Hr. Contact Name & Phone <Hfe�RON Emnactg, <br /> W <br /> x <br /> " 9 y an y Proper pP°'9 ram <br /> 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of the<ond nmern are fully d accurately described above b shi a and are classified <br /> Q .er proper condition for transport by highway«cording to opplkable federal,sic <br /> packed,mocked,and labeled.and arc in all respecriro and ir,temotional bws. <br /> V <br /> 11 1 am a large quantity generator,I certify that I have a program kr d of a reduce the volume and toxicity of waste ge«rolm to the degree I have determined and ut f <br /> J <br /> economically practicable and that 1 hose selected the practicable method of treatment;storage,or disposal<urrcr,ty available to me which minimizes the preserN and fuM <br /> .a threat to.human health and the enviromtent;OR,if ham a small q,wnfity generator,1 have made a good faith effort to minimae my waste generation and select the be <br /> N <br /> waste management method that is owgabk to me and that I cand4 Sig Day <br /> O Printed/Typed Name Sigr,an,rc <br /> v QA-eTT" L. E O 3 <br /> Z T 17. Trans rte,1 Acknowledgement of Receipt of Matedak Month Day <br /> O N Printed/Typed Name ;i Sig a <br /> = Sc < EL <br /> w P <br /> 0 18. T rtee Acknowled emmt of Rec ' t of Maroriah <br /> w c Mornh Day <br /> Priwed/rypecl Acme S,grwNrc <br /> Q0 E <br /> R <br /> W 19. Diwreponcy Indication Space , <br /> N <br /> Q F <br /> U A <br /> Z <br /> _ 1 <br /> k20. F <il' Owner or rano,Certification of re,ei tof hazardous material ow red b this moni st...r t as noted in Nem 19. <br /> mooth Day <br /> T p d d Name- �/j/J�) Sig tur _ 1 <br /> V /TY�� y lir/� ' d 13 L2 I I <br /> DO NO RI E BEL W T L E, <br /> I <br /> White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 D< <br /> OTBG 8022A (7/92) <br /> To: P.O. Box 300, Sacramento, CA 95812 <br /> EPA 870P 22 - , <br />