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r Form roved OMB No 2050-0039(Expires 9-30.94) See Instructions on back'. age 6. >r of TOR Cont. <br /> c Please,pttM or. r- forn&-9 esigned for use on elite(l2pitc writer. -_ t. Sattammn <br /> UNIFORM HAZARDOUS Venerator's US EPA ID No. Manifest Document o. 2. Page 1 Information in the Sts <br /> WASTE MANIFEST k not.required by s=ederw. <br /> 3. Generator's Name and Mailing Address <br /> ance Liver'n National ratorp, S€t€. 300 <br /> 7000 EastAvenue, Li re_ CA 94550 <br /> to <br /> a. Generators Phare (510) 422-1925 AA": A. Witt L-620 <br /> p 5. Transporter 1 Company Name 6. US EPA ID Number <br /> O <br /> ao Emic�zon, Inc <br /> J r <br /> -� 7. Transporter 2 Company Name 8. US EPA ID Number <br /> Q <br /> U <br /> � 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> Ca Z Z <br /> L0 O ERICKSON INC <br /> LO 25,5 Parr Blvd., Richmond, CA 94801 <br /> RZ* U ICIAIDIOIO1914 8 6 3 9 2 <br /> 00 Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> 00 = No. T Quantity <br /> N Wt/Vol <br /> H a <br /> 3 G Non RCRA Hazaraous Waste,Solid (Ernpty ucontalners Last Containing <br /> o f Diesel Fuel)(,Mth associated i in. ; 01012 T P p <br /> 00 N b. <br /> 00 E <br /> R <br /> o A <br /> T C. <br /> 00O <br /> R <br /> W <br /> Z d. <br /> Z <br /> W <br /> U <br /> W <br /> N <br /> Z <br /> 0 <br /> n. <br /> V) <br /> W <br /> J <br /> Q <br /> Z <br /> 0 15. Special Handling Instructions and Additional Information <br /> Z EMERGENCY CONTACT: (510) 447-63380 <br /> Wear protective clothing While handling These materials are NOT radioactively contaminated. <br /> HWM Requisition Numbers 1-{131464, H 13'46—;, <br /> J are that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> 16. GENERATOR'S CERTIFICATION:.Thereby decl <br /> Q packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> U i <br /> .� If I am a large quantity generator, 1 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 /> CL J economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> threat to human health and the environment;OR, if I am a small quantity N q ty generator, I have made a good faith effort to minimize my waste generation and select the best <br /> � p�w�a(stepmana gement method that is available to me and that I can afford. I <br /> 0 P6GNlI(�N`?e t uDEu O�r BfN�i�F o F Signature Month Day Year <br /> �- Q wf•tllvwl'CLt17].7L��JNi>':N bttn WISk-416 Wf LLRf L (� d <br /> U <br /> Z T 17. Trans orter 1 Acknowled ement of Receipt of Materials 7 <br /> R <br /> WW a Pri ed yped Name <br /> N v / -�+,�� Sig-11 na �% A `,--^-� 4 Mon Da or <br /> P <br /> 0 18. Trans orter 2 Acknowled ement of Recei t of Materials <br /> W R <br /> LL T Printed/Typed Name Signature <br /> E Month Doy Year <br /> O R <br /> W 19. Discrepancy Indication Space <br /> N <br /> U A <br /> Z <br /> L r <br /> 1 20. Facility Owner or 012erator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. --� <br /> T Printed/Typed Name i (Signature <br /> Y ' <br /> i \ I I Month Doy Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (7/92) <br /> EPA 8700--22 <br /> -,nc le <br />