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- Approved OMo No. _r:J39(Expires 9-30.991 See Instructions on back of page 6. Department of Toxic Substances Contrei �cse print cr type. Form designed For use on elite(12-pitch)typewriter. Sacramento,California UNIFORM HAZARDOUS 1. ator's US EPA ID No. Manifest Document N 2. Page 1 Information in the shaded areas d is not required by Federal law. WASTE MANIFEST 12-01 If 1010IZQ31 1 01 Z of 3. Generator's Na a and M�ail_ng Add ess r .�7 C �— ! � `r�,. f A SFote Momfest Doament Nusnbar Q t. � y -�G GLt 51 .e - ,®Gs� x S'C�cc�7� UL fO�7 /C�a �F t'`�r:f=` .i re'�c1 �ih cri4C "ye�svE; [4)r-' ��Sr�. ' .��zfC✓�Cf�� l�1. qs'^9� C��`i B. Slate'Genoratos'sID�`Goryn=ytz �, d. Generator's Phone(.2 e7) zi.Fv,. - ? a�fy/ 3T�Q 5. Transporter 1 Company Name 6. US EPA ID Number C.Slate Trensporters ECOLOGY CONTROL INDUSTRIES 1 Dsi*rF spotters Phan® S IZA��Xr �.. � 7. Transporter 2 Company Name 8. US EPA ID Number E State Tronsporter{s ID 7., 1 I 1 1 F.'Trans rters Phone r t 9. Designated Feciiity Name and Site Address 10. US EPA ID Number G. Slate FacfliVs.1D '- ERICKSON INC. �j. ,k ;�r t z �• x , z 255 PARR BLVD H. Facdty's -A 948011 ' t tOrii :3k el rr r A T !. y4 11. US DOT Description(includingProper Shipping Name,Hazard Class,and ID Number I . ontainers 13. Total 1d. Unit No. Type Quantity WIN L`Waste Numbers WASTE EMPTY STORAGE TANK . c;i. ,,oCM State;'`` EPA/Other Nb• Slate.? LI E R EPA/Other SIG R EPA/Other"!:$:.; d. Stab EP 1 .Additions!Descrspnons for Materials Listed Above <Handling Cadei far Wastes tiled- f �4:_ a fee; -.c, s,M• r'! 1'r e� '�� a; �1'+" _��k r s .��'; "�ar:li`a s:�, g :tan s. .. le� �' °°.y 1 mss`' s~• ° s�'0vr, '4'1 Y i � o- �F,k B Ytlar}' �si t}e"'mss s$'vV� L a.:f3,'s .�`'�t1t 1' ''�y r N �,we_ 6' i Jfr(/�}^''; v r£i°•�sk`r�'1' s } r.`n°''_�. .F7�+.� r QTY EMPTYBTORAGE TANKS)# ® { - 6s•A� aS�!? � ^�� iTsa_t.i }s'tr"� ? 'r. s mi-& r d ` r» ` TAN}C(S)�k{AVE BE��EI�lNE2 Ef Ti 1 s Y 15. Spacial Handling Instrodions and Additional Information t .- � Wear appropriate protective clothing when handling. SITE LOCATION:SAR/0,7 24 Hour Emergency Telephone Number. ?a9 q -?S��% ,`i9 jweU. 24 Hour Emergency Contact: ERG# 171 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, marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and notional government regulations. If I am o large quontiry generaror,1 certify that 1 have o proggram in place to reduce the volume and toxicity of waste gennroted to the degree I have determined to be econorth practicable and that I hove selected the rracticabla method of treatment,storage,or disposal currently available to ma which minimizes the present and future threat to human haat 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 available to me and that I can afford. Printed/Typed Noma Signature Month Day Year 1 17. Transcor:er 1 Acknowiedcement of Receiot of Vo!eclo!s A A Prir- /T,o Name Sign '.e i nth Day "ear 0 B. Tronsoorter 2 Acknowledgement of Receipt of Materials R Printed/Typed 7 Name Signature Month Day Year E R 19. Discrepancy Indication Space F A C i L 1 20. Facili Owner or Operator Certification of receipt of hazardous materials covered by this manifest exceot as noted in Item 19. T Printed/Typed Nome Signature Month Day Year DO NOT WRITE BELOW THIS LINE. C 8022A(d/97) White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. 8700_22 To: P.O. Box 3000, Sacramento, CA 95812