Laserfiche WebLink
State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30.99) See Instructions on backge 6. Department of Toxic Substance Control <br /> Please print or type. Form designed for use on elite(12-pik riter. Sacramento,California <br /> 1• Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded <br /> UNIFORM HAZARDOUS areas <br /> WASTE MANIFESTis not required by Federal law. <br /> 8Z 0 020 Z �o of <br /> 3. Ct;9lrator''s Nam.3 and Moiling,Address <br /> G /�/3bl I/�1VJI -^ N Tla�l+e�1 <br /> ,n r oGfCc o/�/ GA !$x -..10LO , <br /> 4. Generator's Phone(K ) 93 40ry t <br /> G q <br /> N S. Transporter 1 Company Name 6. US EPA ID Number <br /> W) <br /> TRIDENT TRUCKLINES <br /> m <br /> 4181 13 It 10 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number <br /> J <br /> J <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> >Z ERICKSON INC. ; <br /> p 255 PARR BLVD <br /> U <br /> Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 1 ontainers 13. Total 14. Unit ` <br /> Z P ( 9 P PP 9 No. Typa Quantity Wt/Vol ,.„ps um <br /> 'Z a. <br /> WASTE EMPTY STORAGE TANK <br /> Cb. <br /> ;i E d O b P <br /> O N <br /> co <br /> coo E <br /> v R <br /> v A <br /> 00 O s� <br /> R <br /> LU <br /> s <br /> LU <br /> d. <br /> Z <br /> V � <br /> J'Addehona[Descr�pbons foc MaPonafaUstsd' e ' 4 �` T K Handling Codes For Wastes,Usted' <br /> yq 1 ,7s i•: �., ,. <br /> y ���wk s. , E �Yt-V 4 y4+, '�• arS � �+ .o �`. g CsY^,iv n 4�,...: 4. Y°� � � a!� s�*a <br /> `4,sle. .EMPT I.raYQrr WE <br /> r TANK(S '1-fA�lEElEE11fjN ,� *WITFf. ±'cam , §§ ff rf�f d5 1AS DRY 101=PER <br /> Y � <br /> � <br /> Z <br /> 15. Special Handling Instructions and Additional Information <br /> z Wear appropriate protective clothing when handling. SITE L0CATI0N:3_hhWf- o T <br /> 24 Hour Emergency Telephone Number:(a,OJ) IS —XS-6 0 <br /> = 24 Hour Emergency Contact: bt5e/k,cA.�- e 0BsEQeX,oer RG 171 <br /> Q16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and a classified,packed, <br /> J marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> J <br /> IF 1 am a large quantity generator,I certify that I hove a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> n practicable and that I hove selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> r and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> Printed/Typed Name Signature P. Month Day Year <br /> L � <br /> T 17. Transporter I Acknowledgement of Receipt of Materials <br /> R <br /> Yj A Printed/Typed Name <br /> SA <br /> RS Si re Month Day ^Year <br /> J_ [ <br /> P <br /> 0 I8. Transporter 2 Acknowled ement of Receipt of Materials <br /> TPrinted/Typed Name <br /> E Signature Month Day Year <br /> t <br /> R <br /> F <br /> 19. Discrepancy Indication Space <br /> A <br /> C <br /> I <br /> L - <br /> F 20. Facili Owner or O erotor Certification of recei t of hazardous materials covered bv this manifest except as noted in Item 19. <br /> Printed/Typed Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> -)TSC 8022A(4/97) White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> :PA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br />