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0--fanviranmenral Protection Agency <br /> fOMB No 2050-0039]Expires 9 30 99) Seo Instructions on back of pie 6 D��e of Toxic Su�waes Contrci <br /> F or type Form designed for use an elite(12 pack)fypewrrier JZ-p$ Suicrani�ib Calli(orinw <br /> UNIFORM HAZARDOUS 1 Generator s US EPA ID No Manifest Document No 2 Iloilo re <br /> o I Infoiai&oe in ee <br /> the shaded aas <br /> is not iequrrd by Federd law <br /> WASTE MANIFEST s of 7 <br /> 3 Generator'�jem� ding Addras& <br /> i //rrJJ <br /> 10 Loprr' C.4 <br /> in t Generator's Phone <br /> �1SZ <br /> 04 5 Transporter 1 Company Name 6 US EPA ID Number <br /> to <br /> o FULLER EXCAVATING AND DEMO <br /> 7 Transporter 2 Company Name B US EPA ID Number <br /> r <br /> J <br /> a <br /> V 9 %I ria d Facdi Name and Site Address 10 US EPA ID Number <br /> d ER1�7CSON NC <br /> z 253 PARR BLVD <br /> Cie <br /> O RICHMOND, CA 94801 <br /> Q 1♦ thsit <br /> J <br /> 11 US DOT Description(including Proper Shipping Name Hazard Class and ID Number] 12 No Con tamors 13 Tonal <br /> T Ouanhy wt/Vd <br /> Z WASTE EMPTY STORAGE TANK <br /> G Non-RCRA hazardous waste solid p TP l P <br />`t N b <br /> E <br /> v R <br /> v A <br /> T ` <br /> a O <br />- R <br /> u d <br /> s <br /> u <br /> J <br /> u <br /> n <br /> a <br />} <br /> 4 <br /> 7 <br /> J <br /> C <br /> t <br /> 7 15 Special Handling Instructions and Additional Information <br /> Wear appropriate protective clothing w handling. SITE LOCATION: 10d Gv T <br /> 24 Hour Emergency Telephone Number ZZs�y�3.._ a3 c0.04 C,-- <br /> 24 Hour Emergency Contact: fj liu ERG 17 <br /> 16 GENERATOR'S CERTIFICATION I hereby declare that the contents of this consigm <br /> nent are Fully and occuratel described above by propw shipping name andro aclassified pocked, <br /> marked and labeled and are in all respects In proper condition for transport by highway according to applicable international and national government regukstrons <br /> i <br /> IF I am a large qua,I generator 1 certify that I have a p ram in place to reduce the volume and toxicity of waste generated to the degree I have deten+ried to be etaiso<oiealfy <br /> practicable and that I haw selected the procticable method of treatment storage or disposal currently available to me which minimize&the present and future-moor to humans health <br /> and the environment OR if I am a smolt quantiy generator,I have made a good faith effort to minimize my waste generation and soled the best waste management method that is <br />] available to me and that I can afford <br /> P"i". / Name Signatu Mars Day Year <br /> i T f 7 Trans orter 1 Acknowledgement of Receipt of Materials <br /> tA rinted lypod Name Si torr—` Mad+ ow <br /> �aP4 <br /> 6 18 Trans over 2 Acknow44 aceipt of Materials <br /> TPrinted/Typed Name fore Mori Day Yew <br /> F 19 Discrepancy Indication Space <br /> A <br /> C <br /> I <br /> L <br /> ( 20 Focih fOwner or O orator Certification of receipt of hazardous materials covered byis manifest exce t as noted in Item 19 <br /> r y ad G Nms Ssgnotureti r — � O Da1� Yew <br /> DO NOT WRITE BELOW THIS LINE. ` <br /> White TSCF ]ENDS HIS C�?Y TO otT, mTHIN ..0 <br /> TSC 80221, (4/97] <br /> sA 8700-22 To P O Box 3000 Sacramento CA X581 ti <br /> r <br />