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yrala Dr I"�"_ ~'" i �hlat '-' ...Vfll lanry "• .y/) / r <br /> Form Approved Oka No 2050-0039 tExplres 9 30 991 See Instructions an back of pogo 6. /{1�j4 LJ` Dapartene"It ofTeslasubstances Control <br /> ►16-14 Fn a+or typo Foran derlgnad for use on ehre f r2 ptrcf rj rnm-rrrae Socmmenta Callfornlo <br /> UNIFORM HAZARDOUS 1 Generat"a US EPA ID No MoMfeat Documanl No Z. Pape 1 Informaden{n the shaded oraaa <br /> M f, is not required by Fsdarol In- <br /> WASTE MANIFEST 5 pr I <br /> 3 G"oralor s Name and Marling Address <br /> 233 Go ns w��y -11101 SAGA A5111c. CfS�+z- <br /> d Generatoes Phone{ ' lt 1x771 5T& X7 3 <br /> hS Trvnsporler I Company Name +r f r 6 US EPA 10 Nwnbor <br /> m <br /> CONTROL INDUSTRIES A irj�qigi%nia in ii r7- is <br /> 7 Transporter 2 Company Name B US EPA ID Number <br /> a <br />.�U 9 Dgslgparod Fodllty Nome qnd She Address 10 US EPA ID Number <br /> aOz ERICKSON INC <br /> 255 PARR BLVD <br /> RIGIIMGND� GA 94801 w�o <br /> V�Q1 ntarnars 13 Twor 14 U>,q <br /> V i l US DOT M.criprlon briOudmg Proper Shlppinq Norna Hazard Class and ID Number) No hrpm Ouonhy wl/Vai u <br />'0= WASTE EMPTY STORAGE TANK <br /> n� <br /> e P € "If,r <br /> N b 5 =v <br /> Q R !h•r �}'� <br /> Iq A ` <br /> 6 T <br /> aD O ep 'Prher <br /> Uj <br /> d Shl14 <br /> L) EPA C>Skter <br /> W <br /> Z it! r e rlptlem <br /> I <br /> ,� r 9, <br /> 4 r <br /> z7 �E <br /> z Ys * S <br /> pecra and Ing m.lrvchans an dl IOna n ormarleq <br /> Wear appropriate protective clothing when handling. SITE LOCATION: <br /> W 24 Hour Emergency Telephone Number: C <br /> _ <br /> :dRT IF 16 GENERATOR S CEAT101d —I hereby declare That the cis his o 11sis mnsi nmemf Ora f r and gccura+elr deserlbed above 6y proper shipping name and aro classified pocked <br /> Vmarkod and labeled and are In all respects In proper condahaq For Ircimport by W6woy according to applicable Internalrona)and nal+onal go-orntnenr regulations <br /> If I am a large quanliy genaroror 1 cerdry that I have a pmgrapt m piece rp reduce the wk imo and rozlelly of s+otle ganeraiod to the dogma I have determined to be economically <br /> a- pracllcabre and Thal I have seledad the prachcable m+thad aF trearmenir storage or d,spoaal currently awJablo to me.h'ch rnlnlml2m rhe prerenP and Future Ihraor to human hoolrh <br /> sn and the en. ronment,OR it I am o IM411 quanrrry generator I have made a good Faith effort lo minimize my wove generation and select the best waste rnanagement method that Is <br /> m available to rrto oml that I can afford <br /> O <br /> } PAnted/Typed Name Sig ro Monlh Day Yaar <br /> Ran 17 Trrter 1 Aeknowle arrant of Recer t of Materials Q <br /> iPrinre d Npm,e e <br /> M �— g rstanr Day ea <br /> S <br /> ss. 4 18 T ns ortar cknovrhd smenr of Reeel r aE Materiels <br /> O Printed/Typed Name 510 Month rwy year <br /> LU E <br /> to R <br /> 19 Drscrenancy Indlearlon Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> F NDN1,0 <br /> cllr o.rnor or O eralOf Certlhcatron of recel t of hazardous rnararrOls aav6rod Ihn rrwnlfast e�q rat noted rn Item 19 <br /> T /Trpad. acne Slgnaru� ` �n1h Day � a� <br /> Y EfT]A e--:� it <br /> 0 DO NOT WRITE BELOW THIS LINE <br /> DISC 8022A 14/971 white TSDF SENDS THIS COPY TO DTSC wITHIN 30 DAYS <br /> EPA 8700-22 To P 0 Box 3000 Sacramento CA 95812 <br />