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06.26•'96 14 : 09 FAX 714 5211 -3570 SHELL HAZ WASTE Z004
<br /> Stole of CaNforn ermrolum 101 Rofatkn Aoency
<br /> Form Approved OMIT No,21330-0039(Expires 9. 0,94) See fnr Vlflons on bock of page 6.
<br /> Pleme print a type. form d"ANd for (72pgd)ypewrebr. Deportrwent of Toxic 5ub+aesssa C."
<br /> $OCrQtItMeO,California
<br /> UNIFORM HAZARDOUS 1 C*erwaror s US EPA tD No. M nifoo Document ria. 2. pogo 1 fnfonnation in the shaded areas
<br /> WASTE MANIFEST i I is no required by Fed& low.
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<br /> Cp S. Tnwuwrlar I Company Nome` 6. US EPA Ip Number
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<br /> 7- Traraporhr 2 Company Nance B. US EPA ID Number T
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<br /> �Z 9. De1igtvofwd1 Facility Nome and Site Address 10. US EPA ID Number
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<br /> Z 11. US DOT besaiptiart(mdu�r roper 4 Proper "Name,Hazmd Class, Co-anw,% 13. Total 1A. nit
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<br /> p 19. SpecialHand"InsRvctiont and Additional Informaion c'AL:`r-v
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<br /> Z _.} F!%UP =uER�lCY '��N� PJL'ME�? �' a? c=t—_�Gt'J 74: ;�AIPt
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<br /> 16. GENWATOWS CERTIFICATION: I heronry dedore Mat the coMerrts of the cansignmert aro fully and accurately de%c ibed above by proper shipping name wed are classified,
<br /> Qpacked,marked.and labeled.and are in all rersici s in proper condition for transport by highvmy occordmg to applicable federal,state and intemaftnal lays_
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<br /> If 1 am a large quantity generaor, I certify that I hove o program in place to reduce the volume and roa,aty of wmac generated to the degree I hove determined to be
<br /> eeonamicaPy practicable and that I have selected the practicable method of rreatment,storage,or divosal cvrmwly available to me which m nimizes the present and future
<br /> threat to human health oad the envirarvnorr% OR, if 1 om o snail quartan generator, I have made a good faith effort to minimize my woste generation and select the best
<br /> Cr waste manage—rt method that is available to mo and that I con afford.
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<br /> Z T 17. Tram orter 1 Aeknowled emem of Recei r of Moter;als /
<br /> A' printad/Typod Name ignon,re` idonth Day Year
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<br /> 0 1g, Tromporter 2 Ackrwwled urn w of Roceipt of Marrriok
<br /> T Prlmted/Typed Nome Signature Month Day Year
<br /> w 19. Discrepancy Indication Space
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<br /> j20. Facility OW"er or Oporcoor Certification of petal ?of hazordcus maeeriols covered by this manife"except as noted in Item 19.
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<br /> No �Signat4t� Month Day Yeo,
<br /> DO NOT WRITE BELOW THIS UNE.
<br /> DISC 80:4A (12/91)
<br /> EPA 0700.-22
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