Laserfiche WebLink
State of Califomio—Environmental PratectiGn Agency <br />Form Approved OMB No. 2050-bW9 (Expires 9-30-94) <br />Please print or type. Form designed for use on elite (12 <br />See Instructions on back o0ge 6. <br />UNIFORM HAZARDOUS I Generator's US EPA ID No. Manifest Document No. 2. Page I <br />WASTE MANIFEST �'D CAD I ) 1918111416 10 12 11151 -1 31 Q18 9 of <br />3. Generator's Name and Mailing Address <br />D SHELL OIL COMPANY <br />n HAZARDOUS WASTE DEPT. <br />r) <br />P.O. BOX 4848 <br />r) 4. Generator's Phone (714) 520-3312 ANAHEIM. cm '928035. Transporter 1 0 <br />Company No 6. r -4 <br />:.-P nr "N5 15P to(- 3'� <br />I - P;p J I100 I I <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />Department of Toxic Substances Control <br />Sacramento, California <br />Information in the shaded areas <br />is not required by Federal low. <br />9. Designated Facility Name and Site Address TO. US EPA ID Number <br />ERICKSON, INC. <br />255 PARR BLVD. C A D 0 0 9 4 6 G 3 'H.,Fad <br />Containers <br />1. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. 13. Total 14. Unt <br />No. Type Quantity <br />—NU wt/Vol <br />,JIMUN ful HFURRIDUr WASIE SOtID9V YVazte?'kiniber <br />N Amg I <br />P <br />N <br />0 0 1 '7' P 15 10 1-010 PWi-, I <br />OEM <br />b. <br />C. <br />15. Special Handling Instruction and Additional Information <br />FPCIL TTY.. <br />. I <br />AVOID CONTACT WITH SKIN/EYES SERVICE STATION <br />24 HOUR EMERGENCY PHONE NUMBER (800) 424-93001 Sple, VICTOR ROAD <br />'UD CP. 95240 <br />16. GENERATOR'S CIERTIRCATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br />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 />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 />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 healnth <br />th and the environment, OR, if I am c- sma:l quantity generator, I have made a good faith effort to winintize my waste generation and select the best <br />ce <br />—1. management m od mat is avc-ilable t.; nt and 'hot I can afford; <br />= <br />Printed/Typed <br />1 <br />Nam SlKa <br />ON Bll��HALF OF Month Day <br />Year <br />U <br />Tur:, <br />C <br />SHEL' 0 0. 1 al 01 31 <br />'77'1 <br />Z <br />Uj <br />T <br />It <br />17. Transporter I Acknowledaement of Receipt of Materials <br />APrinted/Typed <br />N <br />Name s <br />i <br />—F Month Day <br />Year <br />'U <br />P <br />—Transoorter <br />LU <br />0 <br />113. 2 Acknowledoement of Reasiot of Materials <br />U- <br />T <br />Printed/Typed Name <br />Signature <br />month Day <br />Year <br />0 <br />Uj <br />V) <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />120. Facili!yOwner-or <br />T Printed/Typed Name <br />Y i <br />20444160806+3982 JS <br />8022A (12/91) <br />jk 8700-22 <br />I <br />Signature <br />Month Day Year <br />Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />To: P.O. Box 400, Sacramento, CA 95812-0400 <br />