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State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30.99!1, <br /> See Instructions on back age 6. <br /> Please print or type. Form designed for use on elite(1writer, g Department of Toxic Substances Contra <br /> Sacramento,California <br /> UNIFORM HAZARDOUSenerator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST ® is not required by Federal law. <br /> of <br /> 3. Generator's Name and Mailing Address <br /> QD�DT—�F�tt".1,��' A-c2we.ti3 (Qj <br /> Tri �r`r-O/)L 60001, <br /> ht <br /> A. Generator's Phone <br /> tV 5. Transporter 1 Company Name 6. US EPA ID Number <br /> o rPbone :° f <br /> W4 . 'i'Ty*t'Y`c " •�z+ 4x1}1::. a. <br /> 7. Transporter 2 Company Name 8. U EPA ID Numbers t <br /> J rsY <br /> U 9. Designated Facility Name and Site AddressT <br /> Q 10. US EPA ID Number tateFpalUy s IQ ry <br /> I Z ERICKSON INC. da <br /> )0 255 PARR BLVD �IUy Phone,rt r z�,, <br /> 1 Q '. "s_ -.« ria )...=.,,.a <br /> .0 1 1. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 1 t°mars 13. Total 14. Unit r" f xjri. <br /> Z a. <br /> No. Type Quantity Wtoi ( Waste Number <br /> WASTE EMPTY STORAGE TANK <br /> G <br /> EPA/Othor � <br /> N 6. �r <br /> co <br /> co E Stoll k <br /> Y <br /> cv R EPA/Otbar a *" <br /> C. <br /> o T State <br /> co O 1. ter,, h Tse <br /> R EPA/Otfbr r, ` <br /> oc ; <br /> d. , fter, <br /> W <br /> ZState �s <br /> W <br /> V EPA/Other Y <br /> J :Addabonol Descnpboiss <br /> ry Fv tb>for.�Materials ListedNAbove <br /> F . . „ .,. , tes.rstodgoes.orast46ovo <br /> � a Y = <br /> W QTY � EMPTYST®RAGE"fAt .. r” � i t <br /> .B«, .. - v- t _. ."' ..g <br /> r.z ��T TAhtK(8j AVE BEEN'f NERT-E D WIT ,x ;, � ,� <br /> Q •s., t ,_ ..,;', "�F fix:. fit- .. i.r.°'- %*�. ,. 4 F d Y M', i -.. <br /> �Y <br /> Z i FYI 4 <br /> 15. Special Handling Instructions and Additional Information 'i'"t <br /> Z Wear appropriate protective clothing when handling. SITE LOCATION:S <br /> 24 Hour Emergency Telephone Number: uA--t'WO-Op"cA- <br /> 24 Hour Emergency Contact: ERG 171 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,pocked, <br /> Q 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 /> J <br /> ne 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 1 have determined to be economiclly <br /> 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 heaalth <br /> and the environment;OR,if 1 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 /> Y available to me and that I can afford. <br /> J <br /> J Printed/Typed Name <br /> �- /�' Signature Month Day Year <br /> 3 r7 k7 <br /> J T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> r <br /> 8R Printed/Typed Name Signet <br /> S 7 Month Day Year <br /> P <br /> 0 18. Tran!22rter 2 Acknowled ement of Receipt of Materials <br /> T Printed/Typed Name <br /> E Signature Month Day Year <br /> = R <br /> J 19. Discrepancy indication Space <br /> F <br /> A <br /> C <br /> I <br /> l <br /> I 20.—Focirity Owner or Operator Certification of recei t of hazardous materials covered b this manifest except as noted in Item 19. <br /> Printed/Typed Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> )TSG 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 />