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r A <br /> /wMd Protection Agency .:= <br /> 20jo-0039(Expires 9.30,94) Spe Instructions on back of page 6.q�VDepartment of To.k S.boa —C <br /> designed for use on elite(I2-pitch)typewriter. - Sacramento.Ca6loroia <br /> 1. Generofor's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> NIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST G 4 a~ O a 0 I g q I i ig 1 I of <br /> �. 3. Generator's-Name and Mailing ddress <br /> Ct ✓a w US 1� �a-D n�Grs ca-wow <br /> I 'S 4-ct 1A lb , <br /> 1�0. 8ox5�D�t45 . HalTvc 1t/ <br /> N 5 R>Rr,►►nAJ►C A q't5 f33- o Foy S,c�c �rr y <br /> to 4. Generarot's Phone 1,5 It) pit2 QS <br /> m <br /> 5. Transporter 1 Company Nannie 6. US EPA[b Number <br /> ERACKS()A11 TV'jC <br /> ICIAID 1010MAJI(PeW3 <br /> 1 7. Tronsporter 2 Company Name S. US EPA ID Number <br /> a <br /> u <br /> Q 9. Designoted Facility Nome and Site Address 10, US EPA Ib Number <br /> W Erickson,Inc. ! <br /> 255 Parr Blvd. <br /> y a Richmond Ca. 94801 6 3 1912 <br /> U <br /> 32. Containers 13. Total` 14. Unit ) <br /> nz it. US DOT Description( p�ng <br /> ncksding Proper ShiName,Hazard doss,and ID Number) No. I Type Ova" Wt/vol <br /> U~ aWaste�Empty. Storage Tank <br /> �3 <br /> WN-RMA t'�lardous Waste Solid. T P P <br /> C14 <br /> E <br /> W N b. <br /> E <br /> a R <br /> o T C. <br /> C? O ` <br /> s R <br /> LU <br /> Z d' ' <br /> u <br /> w <br /> InZ <br /> 0 <br /> a <br /> Uj <br /> W <br /> x <br /> a <br /> Z 15. Speciol Handling Instructions and Additional Information <br /> a und <br /> Keep away from sources of_ignition. Always wear hardhats when workny t4Iz <br /> Z U.G.S.T. 's 24 Hr. Contact Name & Phone C$iay PX N EmEai: <br /> L <br /> >— y r shipping lassifi� <br /> .t J 16. GENERATOR'S CERTIFICATION: I hereby derte <br /> declare that the cornh of the consignment are fully and otturately described above b grope pp g name and are c <br /> Q in proper condition for transport by highway according to applicable federal,state and intemotional laws. <br /> packed,marked,and labeled,and arc in all respects <br /> V <br /> If 1 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 hhe determined u <br /> economically practicable and that l have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and u <br /> A' threat to human health and the environment;OR,9 1-am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the <br /> V) <br /> waste mane emeryt method that is available to me and that I can afford. Month Day <br /> O Printed/Typed flame Signahsre <br /> ,C3Re-r7- L. r o 3 <br /> Z 1 17. Trans Her 1 Acknowledgement of Receipt of Materials Month Day <br /> W A Printe�d//Typed Name ! Sig re <br /> W s cJ F L. r EL" <br /> W P <br /> o 18. Trans rter Acknowled ement of Ret ' t of Materiah Month Day <br /> W j Printed/Typed ane S�gnoture <br /> LL e <br /> 0 p <br /> W 19. Discrepancy indication Space <br /> N <br /> Q F <br /> V A <br /> z_ <br /> I <br /> L <br /> I 20. F til' Owner or erator Certilication of recei t of hazardous material overed b this mani st exce t as noted in Item 19. Month Day <br /> T P'ni d/Typed Name Sig tut Jm <br /> Y CG6 J\j U <br /> DO NO RI E BEE W T L E. <br /> White: TSDF SENDS THIS COPY 10 DTSC WITHIN 30 i <br /> T, P.O. Box 3000, Sacramento, CA 95812 <br /> ()TSC 6022A (7/92) <br /> - "' EPA 8700-22 <br />