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State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-4039(Expires 9-30-99) See Instructions on back a 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-pitch) iter. Sacramento,California <br /> V3, <br /> NIFORM HAZARDOUS 1• Generator'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 3 "1 J ® ® of q <br /> rator's Nome and Mail" Address i ,..tn� r <br /> -CA / ra,96 `-0"7'/® <br /> n i B S�fs,�vaps[erato s1lX` s <br /> r) ' �� <br /> A. Generator's Phone ( t1 8 oZ �o `_,p+ tr t <br /> N 5. Transporter 1 Company Name 6. US EPA ID NbY Siafem is ID F r4 A <br /> n Number <br /> z Earrs P tip <br /> TRIDENT TRUCKLINES A 2 4 8 4 3 7 0 �`��^ .�s *'P'�"° 1 <br /> x �.a. �$ ¢� m}� a 1Q� 783 288 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E Stald.Tiar porwi g <br /> DR <br /> i �F Trasspoit°r"s�fsorie'� ;7' P�a �y <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G State F M s ID: " ,>' •� <br /> i ERICKSON INC. r <br /> 255 PARR BLVD gm��r <br /> '- <br /> r H�Fa4i i Phone 5 <br /> RICHMOND, CA 94801 616131912 `�� � �_� `��� �,. 51}Q-235=1393,.} <br /> J <br /> Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> l P (" 9 P PP 9 No. TypeQuantity Wt/vol "IWostaNumber , <br /> WASTE EMPTY STORAGE TANK State F <br /> G Non-RCRA hazardous waste solid T P EPA/orher <br /> 512 .r <br /> E <br /> ;NONE <br /> N b' store ' <br /> a: <br /> 3 E <br /> ? R EPA/Other p <br /> i A =ate}^# n� j u. <br /> T C. <br /> State <br /> O <br /> R EPA/Othei 4,4 <br /> d <br /> State r �' <br /> � 5 � <br /> EPA4/Qfher <br /> J�Additional Descriptions for Materials Listed Above K Handling Codes for Wastes listed Above.' t r <br /> '' s�' TANK(Sj F#ALr<E BE;EcN INE TED31yETH-�xr11M 1 <br /> a <br /> 15 LESS bRY tCE PER`100Q GALLONS CAPACtTY� lS, k' `, �dc s V ¢: <br /> j 1 Special Handling Instructions and Additional Igformotio <br /> VV'ear appropriate protective clothing when handling. SITE LOCATION: S 1'F- �SiF-IWO <br /> 24 Hour Emergency Telephone Number: (ntQ-6 98Z-a,3 r 0 �� �_• � <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,packed, <br /> marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> 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 economicallyy <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 heolth <br /> and the environment;OR,if I am a smalquantity 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/ YPed Name � Signature Month Day Year <br /> T 17. Transporter i Acknowledgement of Receipt of Materials <br /> A Printed/Typed Nome Si net <br /> R Month Day Year <br /> S Z O <br /> P T <br /> a 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> RPrinted/T ed Name <br /> E YP Signature Month Day Year <br /> R <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 <br /> L <br /> 20. FaciliOwner orO erator Certificationof recei t of hazardous materials covered 6 this manifest exce t 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: TDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> 'A 8700-22 To: P C. Box 3000, Socromento, CA . 9581 2 <br />