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State of Oolifomia--Environmental Protection Agency <br /> 65 <br /> Form Approved OMB No.2050-0039(Expires 9-30w94) See Instructions on back of@ p b. <br /> p g , Depo ment of Toxic Su stances Cont <br /> Please print or type. fined for use on elite(12.0 writer. Sacramento,California <br /> UNIFORM HAZARDOUS -, Generators US EPA ID No. Manifest DocumM111116. 2. Page 1 Information in the shaded areas <br /> WASTE' MANIFEST19 � 21 81 9101.019101010121 9 4 1 3 '4 0 of is not required by Federal law. <br /> t <br /> 3. Generator's Nome and Mailing Address <br /> O :a 6mmore Nallional Labovory, Site 300 <br /> For#w'U.S.Dept of Energy. <br /> n 7000. 'East AVen[*,,UV*rMor9,GA <br /> C4 4. Generator's Phone"(.510) 422-1925 Attn: A. Wilt L.-820 <br /> 5. Transporter 1 Company Name 6. US EPA ID Number <br /> 00 1T Corporation-San Jose <br /> J <br /> t✓I A I DI 91812131713161614 <br /> -+ 7. Transporter 2 Company Name 8. US EPA ID Number <br /> Q <br /> U <br /> Q 9. Designated Facility Name and Sitio Address <br /> M Z 10. QS EP ID Numb., <br /> ,b ad ERICKSON INC. <br /> u 255 Parr Blvd.,Richmond, CA 94801 <br /> „b.0 CAD009488392 <br /> Z 11. US DOT Description(including Proper Shipping Name,Hozaid Class,and ID Number) 12• Containers 13. Total 14. Unit <br /> 00= a No. Type Quantity Wt/Vol <br /> N t= Non RCRA Hazardous Waste Solid <br /> C� G (residue last contained diesel fuel) (with assocWw piping) <br /> ob oE 0 0 1 TP 0 1 3 Q 0 P <br /> E Nan RCRA Ha us Waste Solid <br /> R (residue last contained diesel fuel).(with ted piping) 0 0 1 T P 00100 P <br /> o A <br /> 00 T C. _ <br /> O <br /> R <br /> w <br /> Z d <br /> Z <br /> w <br /> U <br /> LU <br /> V) <br /> Z <br /> O <br /> tL <br /> V) <br /> W <br /> t1� <br /> J <br /> d <br /> Z <br /> EA aGENC@Instructions and CONTACT:dits1a011nf447ti 0 <br /> z UCLLNL Shipping pec#S-( y IT Job# 152298 Erickson Tank;ft 14783 (11a) & 14784(11b) <br /> Wear Reference Rete Number IWY on the invoice. <br /> _ t a clothing while handing. These materials are NOT radioactively contaminated. <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Upacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international Paws. <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 <br /> a economically practicable and that 1 have selected the practicable method of treatment,storage,or disposal <br /> N throat i human health and the environment)ted if I ra ti small the g posal currently available to me which minimizes the present and future <br /> quantity generator, 1 hove made a good faith effort to'minimize my waste generation and select the best <br /> V) waste 21--agement method that is available to me and that 1 can afford. <br /> Printed/Ty ed Name Signature <br /> Rlctu►r�B Loden=ha"OLLNLta /,1 Month Day Year <br /> Z T 17. Trans orter 1 Acknoment of Recei t of Materials / j <br /> LU R <br /> nted/Typed N me , <br /> N �^�� i nature Month Day Year <br /> wW P w / O L. g <br /> R 18. Trans orter 2 Acknowled oment of Rocei t of Materials -7r Printed/Typed�Inmdicw�io. Signature <br /> LL E <br /> O 6 Month Day Year <br /> u.t 19. Discrepa <br /> V) <br /> V A <br /> Z C <br /> _ I C .�°. l l- 10 _q4 <br /> 1 20. Fic ij i Owner or Z!,locrotor Certification of recei t of hozordous <br /> T Pri atenals co er4d b 4hn mu fifes xce t snot d'n Item 1 . <br /> ted/Typed Name <br /> Y ((� J Signator Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (7/92) Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> EPA 8700--22 (Generators who submit hazardous waste for transport out-of-state, <br /> produce completed copy of this copy and send to DTSC within 30 days.) <br />