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State of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9.30-94) 54�'/1$tIUCiIOf15 Oft back Of b� <br />Please print or type., Form designed for use on efite (f2 -pitch) <br />UNIFORM HAZARDOUS I - Generators US EPA ID No. Manifest Document No. <br />WASTE MANIFEST C �, D 8 1 E 0 2 1 I <br />3. Generator's Nano and Mailing Address <br />0 SHELL OIL COMPANY <br />HAZARDOUS WASTE DEPT. <br />BOX 4848 <br />in 00 4. Generator: Phone (714) 520-3312 ANAHEIM CA 92803 <br />O 5. Transporter 1 Company Name00 US E�IDNumb�erz,4f, <br />Transporter 2 Company Name <br />US EPA ID Number <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />ERICKSON, INC. <br />255 PARR BLVD. CAD 009466392 <br />R1rHMQNn, M. 94 A- . s <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) :::F12. Co <br />al i a .f 9 <br />N ... --- - '—L. L q No. <br />. <br />Department of Toxic Substances Control <br />Saounento, California <br />2. Page 1 Information in the shaded areas <br />is test required by Federal law. <br />Of 1 <br />13. Total 1 14. Unit <br />am Lmm ryhww- <br />15. Special Handling Instructions and Additional Information FACILITY <br />AVOID CONTACT WITH SKINIEYES SERVICE STATION <br />24 HOUR EMERGENCY PHONE NUMBER (800) 424-930101 880 <br />VICTOR (ROAD <br />LCIDII C. -I. <br />16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of the consignment are fully and accurately described above b <br />Packed, marked, and labeled, and are in ail respects in proper condition for transport Y proper shipping name and are classified, <br />anaport by highway way according to applicable federal, stare and international laws. <br />If 1 am a large quantity generator, I certify that I have a program in plate to reduce fhe volume and toxicityof waste <br />economical practicable and that I have selected the generated 4o the degree I have determined future re <br />hr Phealth Practicable quo of storage, d a disposal currently rt to mb to ma which minimizes the present and future <br />throat to human nt me and the environment,. OR, if I amt small quantity generator, 1 have made a good faith effort to minimize +ny waste generation and select the best <br />waste mane ement me -hod that is avaiiabb.: to me a.nd that I can afford. <br />P d/Typed Name + reOI°°� ; ,;L UF Month <br />Day Year <br />-' � i. - v0. / I al ( I al 91 <br />T 17. Trans rter 1 Acknowkd en---- _` ^ • .. - - <br />RA Printed/Typed Name ` <br />0 18. Trans rter 2 Acknowled of Recti t of A <br />R <br />T Printed/Typed Name <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />t I Printed/Typed Name <br />Y <br />20444160806+3982 JG <br />-87 0 (12/91) <br />22 <br />_m ...� <br />Month Day Year <br />Signature <br />Month Day Year <br />i <br />i <br />udous materials cowered <br />this manifest except <br />as rested in Item 19. <br />Signature <br />Month Day Year <br />DO NOT WRITE BELOW THIS LINE. <br />Blue: <br />GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS, <br />To: <br />P.O. Box 400, Sacramento, CA 95812-0400 <br />