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State of Colifomtd—� Epdron salol Pon Agency ¢) ' q� f 8 Repo <br />Form Approved OMB �o iiss -9-3(.9 Sr?d• Instructions 011 back Of b. rtment of Toxic Substances Control <br />fMgase print ori. +°' rm desprad for use on elr7e (1?yoikh) +. ± .. \ Sacramento, California <br />UNIFORM HAZARDOUS 1. rator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shoded areas <br />is not required by feral law. <br />WASTE MANIFEST Id I 0 it/ LZ I `% I t� / of <br />3. Generator's amp and Maili Address <br />to <br />1 k'0XS <br />to 4. Generator's Phone ( Q) 41 a, r a S 7 <br />S5. Transporter 1 Company me 6. US EPA ID Number <br />2��MEa <br />041.argV'J1e 9✓t Cr <br />J <br />—' 7. Transporter 2 Company Name 8. US EPA ID Number <br />Q <br />V <br />9. Designated Facility Name and Site Address 10. US EPA ID Number � z <br />&R, uid" <br />Erickson, Inc. <br />255 Parr <br />r ♦. <br />RighnMdXA. 94801 9141616131912 <br />11. US'DOT . <br />NAM <br />NM—RCM Hazardouse • <br />E Waste ftnptv Storage <br />own <br />It <br />A MEMO <br />MEMO• <br />.. e <br />• s. ��^ �i3` "�A: <br />�:• �. � �: 41w``r�€ ",„`t4 �`�`39; ,Xu, v. .�'z �"���,%n%`�.�*s-"iii �^u"`�r�,✓'�tl"' s� Aa ?"�'� x�;..�,�`i` ,i's'e kr�f„` <br />91 1 1 15. Special Handling Instructions and Additional Information <br />a Keep away from sources of ignition. Always wear hardhats when working around <br />W U. G. S. T. 's 1 24 Hr. Contact Name H .� j`Phone Z'lu y¢ S 7 S'0 U <br />16. GENERATOR'S CERTIFICATION- 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified <br />Vpacked, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br />r <br />It 1 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 />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 />to threat to human health and the onvironmenti OR, 9 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br />ble <br />04 s waste management method that is availato me and that 1 can afford. <br />O Printed/Typed Name Signature Month Day Year <br />U �'/ :- t�r < 9 <br />tZu <br />R <br />17. Transporter 1 Ac6owledgemew of Receipt of Materials <br />() <br />A <br />Printed/Typed Name <br />Signa <br />Month Day Year <br />ws <br />UJP <br />UJ <br />0 <br />18. TranseeELeril Acknowledgement of Receipt of Materials <br />TPrinted/Typed <br />Name <br />Signature <br />Month Day Year <br />O <br />E <br />R <br />y19. <br />Discrepancy Indication Space <br />U <br />F <br />A <br />Z <br />C <br />I <br />L <br />I <br />20. Facility Owner or Operator Certification of receipt of hazardous materials <br />covered b this manifest except as noted in hem 19. <br />T Printed/Typed Name Signature Month Day Yeah <br />Y ® 547\35 3 2 8 <br />DO NOT WRITE BELOW THIS UNE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />(Generators who submit hazardous waste for transport out-of-state, <br />DTSC 8022A (1/95) produce'completed copy of this copy and send to DTSC within 30 days.) <br />EPA 8700-22 <br />