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<br />State Of GalNornla--116Jtth and Welfare Agency I
<br />Form Ap 0. If OMB No. 2050-0038 (Expvea • ifJ
<br />Please ria: or Yyoo. (farm dearpned for vse to h2 -pitch typowmer)
<br />UNIFC)RM HAZARD® t. Generatar's U: EPA M No. tiff
<br />WASTE MANIFEST C IA I T 10 810 01219
<br />5. Genoreto''s Name ane Mailing Addreaa
<br />Parif;`X Ball/EnvironzIental Management
<br />2600 ;ami
<br />Department of HeaNh Saw -4
<br />Toxic Subotonces Control 0-3
<br />Sacramento. Cal -lot
<br />Information in the shaded areas
<br />of la not r.gvired by Fedbral law.
<br />A. State Mana1,Qo�v�ntJ• 8bb
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<br />e. Derioneted Facility Name and Site Addreaa
<br />Erickson Incorporated
<br />® 255 Parr Boulevard
<br />f~" < Richiiddd, CA 94801
<br />"_I 1 I I I I I I
<br />10. US EPA 10 Numoor
<br />F. Tranaponer's Phone
<br />G. State Facility's to
<br />C A D D n
<br />CIAID01094bb3192
<br />p 12. Conta�ler3
<br />aL 11. US DOT 0eecriotion (Including Proper Shipping Name. Hazerd Gass, and 10 Number)
<br />No. I Type
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<br />San Joaquin LocalEealth Dept.. NttzbtirsI 1SFrS•-8�
<br />(ii7C e , ,1866-01 (2000.Gal. LFv.TLA.)
<br />al Handling tnatructione and Additional Information --
<br />ra•tiag Locations 124 Fest. Elm Street, Lodi, CA
<br />b Phone
<br />(415) 235-1393
<br />iS. Total
<br />Ovantity Unit II
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<br />K. Handuno Codes for Wart,
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<br />(415) 823-7777
<br />ERG #27
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<br />Waal. No.
<br />512
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<br />GENERATOR'S CERTIFICATION: t hereby declare that the conlema et Chia consignment ore fully and accurately doscribod above by propbr ahipomo name
<br />end are cla6316ec, packed, marked, and labeled, and in
<br />I, no P- mon, Room
<br />2E050, Dan Ramon, (;A 94583
<br />are nt all reapects prober condition for tranapon by highway according to appbcabto international and
<br />S. State Genbrator's 10
<br />government regulations.
<br />A. Gen:ratoi'3 Phone (408 ) 491--4333
<br />If I am a urge quantity generator, i certify that I have a program in placb to reduce the volume and toxicity of waeto generated to the deoreb 1 have dbtErminod
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<br />0. Tian3poetor 1 Company Name
<br />6, US EPA ID Numbor
<br />C. $tate Tranaponer'a 10
<br />NAmerican
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<br />17. Tran3pon•ar t Aeknowl(�g`ment o Receipt of Matorrylo t
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<br />Enviro=ental
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<br />Y. Transports 2 Company Name
<br />t3. US EPA ID Number
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<br />E. State Transponer's 10 C
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<br />e. Derioneted Facility Name and Site Addreaa
<br />Erickson Incorporated
<br />® 255 Parr Boulevard
<br />f~" < Richiiddd, CA 94801
<br />"_I 1 I I I I I I
<br />10. US EPA 10 Numoor
<br />F. Tranaponer's Phone
<br />G. State Facility's to
<br />C A D D n
<br />CIAID01094bb3192
<br />p 12. Conta�ler3
<br />aL 11. US DOT 0eecriotion (Including Proper Shipping Name. Hazerd Gass, and 10 Number)
<br />No. I Type
<br />z a. Waslte Empty Storage Tank, Non-RC_.RA Hazardous
<br />I- E Waste Solid
<br />M3 N
<br />E b.
<br />n R
<br />A
<br />T
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<br />A�doioE ptayr0�iese�t®�ae'l1e�aa =e , Iced With ¢4# Dry Ice,
<br />San Joaquin LocalEealth Dept.. NttzbtirsI 1SFrS•-8�
<br />(ii7C e , ,1866-01 (2000.Gal. LFv.TLA.)
<br />al Handling tnatructione and Additional Information --
<br />ra•tiag Locations 124 Fest. Elm Street, Lodi, CA
<br />b Phone
<br />(415) 235-1393
<br />iS. Total
<br />Ovantity Unit II
<br />01� Pp 0 0 0 1 F
<br />K. Handuno Codes for Wart,
<br />a. b.
<br />01
<br />C. d.
<br />(415) 823-7777
<br />ERG #27
<br />I,
<br />Waal. No.
<br />512
<br />A/ -RQ
<br />tato �(4
<br />PA /Other
<br />feta
<br />PA/Othor
<br />tate
<br />PA/Other
<br />PC Above
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<br />GENERATOR'S CERTIFICATION: t hereby declare that the conlema et Chia consignment ore fully and accurately doscribod above by propbr ahipomo name
<br />end are cla6316ec, packed, marked, and labeled, and in
<br />-r
<br />are nt all reapects prober condition for tranapon by highway according to appbcabto international and
<br />Nnavanai
<br />government regulations.
<br />If I am a urge quantity generator, i certify that I have a program in placb to reduce the volume and toxicity of waeto generated to the deoreb 1 have dbtErminod
<br />C I
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<br />to to economically peez(ieabfti and that t have selected the prac:rcabwo method of ireafmb it, storage, or disposal cutrenay available to me which minimizes Ina
<br />pri,nent trio future throat to human healtgend the environment; OFI, if I am a ma11 quantity generator. I have m a a good toith ollon to minimize my waste
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<br />goneratien and aeleet the beat wo:te ms i2cmont method +.hat is evadable c and that I ca ford.
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<br />20. Facility Owner at
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<br />Y Printedtl'yood Name
<br />,.., „c,,,,.wuv . - r—w, " imcarf......ronotA 60vefoo DY into men,leat ehceot a3 nafed in Item
<br />OHS e022 A (1 /era)
<br />EPA 8700-22
<br />(Rev. 9-88) Provious editicna ata obsolete
<br />Do Not Write Below This tine
<br />61ve: GENERATOR W40S THIS COPY TO DONS WWITNN 30 OA`
<br />To: P.O. Box 400, Sacromento, CA 958'12-0J00
<br />i tl 1Ir11:>i=ti Il'_
<br />-13i 13-1 t1tTrr13= I•.) — Cirz:0T Tt,r,T- -.3.�
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