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S <br /> Jromia-Environmeedd Protection Agency <br /> ,approved OMB No.2050-0039(Expires 9.30-94) See Instructions on back of page 6. Deporirnenl of To:k Substances C«rt.a <br /> Ps-w Pritt or type. Form designed for sine on elite(12-p kh)fypewrr7er. ft4 of TO-1c <br /> Colitonce <br /> UNIFORM HAZARDOUS 1. Generators US EPA ID No. Manifest Do"ment No. 2, Page 1 Informal in the shaded area, <br /> WASTE MANIFEST J9la 01 W81 1171,54h not required by Federal k, <br /> 3. Generator's Nome and Moiling Address <br /> .ski <br /> �, P,vrBr„c SS S's J <br /> n SRV/ f�n�a�4G p a[� <br /> N LO 4. Generator's �Y� P 7 , <br /> co <br /> 9 5. Transporter i Company Name 6. US EPA ID Number y s <br /> C9 <br /> Erickson,Inc. <br /> 7. Transporter 2 Company Name S. US EPA ID Number <br /> U <br /> V <br /> n Q 9. Designated Focili mP nd S" dress 10. US EPA 1D Number <br /> Z Gibson Oi"1�Pl- otFeLraleum <br /> 475 Sea Port Blvd. <br /> 11 a Redwood City, Ca. 94063P 9 P P7 <br /> V 12. Containers 13. Total 14. Unit <br /> Z 11. US DOT Description(inchrding Proprr Shipping Nome,Hazard Class,and ID Number} <br /> •_ No. T va <br /> On' "/Vol _ <br /> t RQ Hazardous Waste Liquids NOS (Benzene) <br /> G 9 NA 3082, PG I n D018 ERG # 31 Q o ) *TiT a d a ;, <br /> ado N b. <br /> w E <br /> v <br /> R s. <br /> o A <br /> co r �. <br /> O <br /> 'x R <br /> LU <br /> z <br /> d. <br /> `V <br /> O ,15. Special Handlimg lnsiruc s and Ad d"gnpl Info.mation �F <br /> a Gibson Oil ste Stream Profile # /Q ERG 31 V1 `/IY IU <br /> Z 24 Hr. Cont It 24 Hr. Phone# <br /> LU RCj <br /> F- <br /> 16. GENERATOR'S CER TION: I hereby declare that the content,of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> J packed,marked,an beled,and are in all respects in proper condition for transport b highway according to applicable federal,state and international Sows. <br /> Q PK P >x sP Y 9 Y n9 PP i <br /> U <br /> If I am a large qvgenerator, I certify that t have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically procti and that I have selected the practicable method of treotment,sloroge, or disposal currently available to me which minimizes the present and furvre k <br /> CL threat to human he and the environment; OR, if I am o small quantity generator, I have mode a good faith effort to minimize my.waste generation and select the best <br /> srT <br /> waste mono ement shod that is available to me and that I can afford. <br /> Q Printed/Typed Name SigMonsh Day Year <br /> 6 � L. I& rw Q�� H,-Ar 01-3111815!1q <br /> Z T 17. Transporter 1 A ed ement of Receipt of Materials <br /> U <br /> A Prin � Type Namg re Morrtfy Day Year <br /> � s <br /> a <br /> w � <br /> o tl. Trans otter 2 Aclbwled ement of fecei t of Materialsw A !tinted/Typed Name s Signotvre Month Day Year <br /> LL 7 t <br /> 0 to r <br /> LU 19. Discrepancy lncl ition Space <br /> V A <br /> C <br /> r� I <br /> k <br /> 1 20. Faci/T li ped NaOwner r O Aerator Certification of receipt of hazardous materials covered b this manifest except os noted in Item 19. <br /> T Printed Signa a Month Day Year <br /> Y <br /> Q3 <br /> DO NOT WRITE ELO THIS LIME. <br /> DTSC 8622A17192s White: TSDF SENDS THIS COPY TO DISC WITHIN 30 DAYS, <br />