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State of Comore —t—sronmenlol erotechon Ngency <br /> 'IForm Approved OMB No.2050.0039(Expires 9.30.94), See Instryctiorts on back o age 6. • mem of Toxic Substances Cont, <br /> .Please print or type. form designed for use on elite(►?p$ 'er. s Sacramento,California <br /> Generators US EPA ID No. Manifest Document 2 Page 1 Information in the shaded areas <br /> .;UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST / 1-2181910 <br /> e90 10 fg 0 0 e� <br /> 3. Generator's Name and Mailing Address ,,.x f"akr <br /> UMMOO LIVermm ftAWW LAbMIty.00,30.0 <br /> 7000 East Avenue, LivefMOM,CA <br /> 4. Generators Ph-e &10 )422-IM Atte:A.Wilt L-620 - <br /> 6 5. Transporter 1 Company Name 6. U$EPA ID Number <br /> C? Edolm an, Inc <br /> D 16 10 19 14 16 16 13 19 12 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number <br /> U <br /> F. (ansportdl" <br /> Q .a a t..aa:, s . �•'� <br /> Z 9. Designated Facility Name and Site Address 10. US EPA ID Number ate O <br /> " O ERICKSON INC. Awl <br /> ' <br /> .fit±- 255 Parr Blvd., Ridtmond, CA 94841 ff•I•Fcaftty's <br /> s <br /> CO< Doo9ass392 ` <br /> .�♦Z 11. US GOT Description(including ProShipping ) 12. Containers 13. Total 14. Unit a 3 <br /> p (' g per Name,Hazard Class,and ID Number <br /> = No. Type Quantity Wt/Vol q fis♦6`., tuber ` <br /> 3 Von RCRA Hazardous Waste,Solid (Empty Containers last Containing � to® �, � <br /> G <br /> Diesel Fueltft(A assacianed piping) ®21 E <br /> 00N b. oe <br /> 00 r J <br /> � E - <br /> Nv R I EPq/wOther r <br /> o A �>' <br /> w0 O $taro' <br /> Of R EP, <br /> A/Cfther <br /> Z d. i <br /> U <br /> LU EPAjOfherh z <br /> 0 1 Adddwnol Descriptions for Matenals{fisted Above r "'z ? q n 4 45 p Handlmg Codes for Wos?es�sfoel <br /> W ':.� <br /> —� �'�,'iFYitEise'.^ �'f ,y, � -rrE�c'::�' �,cr..♦ �a�,t�¢ : t °'3��",,.Tt+"t_.� jf� � <br /> o- <br /> ZFr"iii' N '^ S#:Y rrx 'r G{nc e" 4 w .� I ?� <br /> Q I 15. Special Handling Instructions and Additional Information <br /> Q EMERGENCY CONTACT:(510) 447-6880 <br /> Z Wear proteo ive c lotWng vMe handling. The3e materials are NOT ra ly con ted. -_ <br /> HWM Requisition Numbers H135764, H135767 gOSPoulli 0ful <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 ore 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 laws. <br /> If 1 am a large quantity generator,l 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 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 /> <n threat to human health 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 <br /> W Waste management method that is available to me and that I can afford. <br /> O Printed/Typed Name Signature Month Do Year, <br /> Ric Mrd 8 Loden on behalf of LLNL <br /> t 17. Transporter 1 Acknowledgement of Receipt of-Materials <br /> LU' N Print Typed 110 ilk V4A $igow4ure Mo Do Ye <br /> w s <br /> 0 16. Transporter 2 Acknowledgement of Receipt of Materials <br /> w <br /> T Printed/Typed Name Si rtaNre <br /> O R g Month Day Year <br /> w 19. Discrepancy Indication Space <br /> to <br /> U F <br /> - <br /> A <br /> Z I O <br /> - 1 <br /> 1 20. Facility Owner or razor Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed yped-Name <br /> Sig remonth <br /> Yt'�� v �_ O Day Year <br /> 0 3 <br /> A CM THIS LINE. <br /> 4.i.i�P tom..^-., • <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br /> A_(12791). N€i r (Generators who submit hazardous waste for transport outof-state, <br /> produce completed copy of this copy and send to DTSC within 30 days-) <br />