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State of Colifomia—Environmental Protection Agency
<br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back9e 6.. Deportment of Toxic Substances Control
<br /> Please print or type. Form designed for use on elite(12-pitch liter. V I Sacramento,California
<br /> UNIFORM HAZARDOUS 1. Genarotor's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas
<br /> WASTE MANIFEST r is not required by Federal low.
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<br /> 3. Generators Name and Mailing Address Di r"rZ, Ems..j?t-- l t.�`Sc.OnO 1� uman a— x M
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<br /> 4. Generator's Phone .07( F
<br /> N 5. Transporter 1 Company Name 6. US EPA ID Number fid,ta[ Tsxsa ' fi a', �`' r' ag'a
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<br /> o TRIDENT TRUCKLINES DI 91®121418141317 O 2'
<br /> 7. Transporter 2 Company Name 8. US EPA ID Number
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<br /> 9. Desi noted Facili w
<br /> Name and Site Address 10. US EPA ID Number G State Ficial, t $ r
<br /> Q ERIWON IKIC. .. ,.
<br /> Z 255 PARR BLVD ,
<br /> 0 RICHMOND, CA 94801 P IAI ® 9 4 6 6 3 9 2 �aclt�sktt
<br /> 235
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<br /> Q 12. Containers 13. Total 14. Unit yA '}t
<br /> V 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 4�$g
<br /> No. Tye Quantity Wt/Vol - .. VasM Numbea';�.-
<br /> Z WASTE EMPTY STORAGE TANK s51z= ;
<br /> 3 c Non-RCRA hazardous waste solidc ) T11 7jr
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<br /> EPA/Other �� ,•y �p
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<br /> J. Additional Descriptions Fo M feta AFry ` " r K dandling Codes for Wastes Listed Above _
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<br /> d QTY ,. ..EIAPs 9 SrYI�C7E'TANI�8)uj
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<br /> n_ ' ` tC{ ;:HAYt ,BEEN INERTEt3WIT t4VK. x
<br /> J 15 LBS DRY ICE PER 1000 GdLLONS CAPACITYzy `° >� "d
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<br /> Z .� .._ ,�.- ,-. -,.. ..: rsr.<,i. ., ....:�,sa .a ar ,.> .K,i�?` ,�Y � 4ty� i4 r+� •-a',x; ,.,..,,^ 'B�,,
<br /> 1J�Jefei'°ajn6Yb'P'ra�'�°°�P��enC'>�ifve'clothing when handling. SITE LOCATION:S
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<br /> 24 Hour Emergency Telephone Number: Cacq, SSS.--Z-��? i�,�:;,.�, a s` ►r
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<br /> 24 Hour Emergency Contact: p, -rc.-A o - tv a _ ERG 171
<br /> 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classiFied,packed,
<br /> Vmarked,and labeled,and are in all respects in proper condition For transport by highway according to applicable international and national government regulations.
<br /> —J+ IF I 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 have determined to be economica11
<br /> N practicable and that I have selected the Practicable method of treatment,storage,or disposal currently available to me which minimizes the present and Future threat to human health
<br /> 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 /> ce available to me and that I can afford.
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<br /> }• Printed/Typ d Name Signature Month Day Year
<br /> T 17. Transporter 1 Acknowledgement of Receipt of Materials
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<br /> W M Printed/Typed Name Signature
<br /> Month Day Year
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<br /> 0 18. Transporter 2 Acknowledgement of Receipt of Materials
<br /> 0 RPrinted/T ed Name
<br /> T Printed/Typed Signature Month Day Year
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<br /> V 19. Discrepancy Indication Space
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<br /> I 20. Facili Owner or O erotor Certification of recei t of hazardous materials covered b this manifest exce t as noted in Item 19.
<br /> T Printed/Typed Name Signature Month Day Yeor
<br /> DO NOT WRITE BELOW THIS LINE.
<br /> DISC 8022A(4/97) ,Ajhiie: TSDF SENDS THIS OPY TO DTSC WITHIN 30 DAYS.
<br /> EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812
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