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State of Colifornia—Environmental Protection Agency See Instructions on back O e 6. De rtment of Toxic Substances Control <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) 9 Pa <br /> Please print or type. Form designed for use on elite(12-pitch) dler. Sacramento,California <br /> 1.F3L; <br /> NIFORM HAZARDOUS 1• eh®rotor's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST In A Q (� Q of 1 <br /> rator's Name and Mailing Address <br /> .0voo <br /> 5a�YuOb00/ aLf2 S /OS Gan®r`oror'',IORR fi' K <br /> 7 u .. . <br /> n <br /> A. Generator's Phone( ) <br /> v S. Transporter 1 Com an Nama 6. U5 EPA ID Number a +F • [' _1' w ;vT' <br /> TRIDENT TRUCKLINES IA 1 918121418141317 10 `A" ,drSO� 183288'�;a <br /> 8. US EPA ID Number ( Y <br /> 7. Transporter 2 Company Name uRl <br /> a <br /> S Pf10' <br /> J 10. US EPA ID Number G tateEaetlG D y,.'",G#e� <br /> 9. Designated Facility Name and Site Address um ? ysI <br /> d ERICKSON INC. .:; <br /> Z 255 PARR BLVD Pactll :Phone z +fi a <br /> ,RICHMOND, CA 94801A0101946161192 . =2 35 1393f <br /> 12. Containers 13. Total 14. Unit <br /> J11. US DOT Description(including Proper Shipping Nanta,Hazard Class,and ID Number) No. Type Quantity Wt/Vol 1 Waste Number, G <br /> Z WASTE EMPTY STORAGE TANK S�+o 'a512 ` <br /> G Non-RCRA hazardous waste solidT P EPA/Other <br /> NONE:t <br /> N b' <br /> 35 E EPA/Other <br /> T C. Stoto r;Z 1 m <br /> b O EPA/Ckhar Y" r <br /> R <br /> Stole <br /> d. a <br /> Z EPA/Other b ' <br /> J. Additional Descriptions.for Materials Listed Above$ ® f K_Handling Codes for Wastes Listed Above <br /> m <br /> ` S <br /> 1 CITY 1 EMPTY;STORAGE TJ4rl t( } <br /> —�- <br /> TAN1U 1 VE BEEN INERTEQ TH d <br /> a 15 LBS DRY ICE PER 1000.GAltONS CAPACiK <br /> Z 15 Special Handling Instrqctions and Additional Ipformatm <br /> Wear appropriate protective clothing when handling. SITE LOCATION: <br /> L , P, C-4 <br /> Z 24 Hour Emergency Telephone Number:(ao�-) ri 131 —�7 ro o P3�r�r.,��4�Pco' , p <br /> 24 Hour Emergency Contact: _ T ERS 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,packed, <br /> Q marked,and labeled,and are in all respects in prober 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 1 have o program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> °- practicable and that ftave selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> h 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 /> a' available to me and that I can afford. <br /> OPrinted/Ty ed Name Signature nt� ay Yea <br /> Z �EFF"iY /� 9 <br /> w T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> � p Pri d/Typed Name Si ure Month Day Year <br /> ---7"LU <br /> LU <br /> S 0a Z <br /> U- 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> 0 T Printed/Typed Name Signature Month Day Year <br /> LU V) E <br /> Q R <br /> V 19. Discrepancy indication Space <br /> Z F <br /> A <br /> C <br /> I `; <br /> L <br /> t 20. Facility Owner or Operator Certification a hazardous materials covered by this manifest except as noted in Item 19. <br /> Printed/Typed Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> White: TSDF SENDS 'HIS CGPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A(4/97) To: P.O. Box 3000, Socrrmento, CA 9581, <br /> EPA 8700-22 '* <br />