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State of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30.94) See Instructions on back of Joe 6. Department of Toxic Substances Control <br />Pk se print or,type. Form designed for use on elite (12 -pitch) fyp..Mor. Sacramento, California <br />UNIFORM HAZARDOUS 1. Generators US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br />WASTE MANIFEST prat required by Federal law' <br />r' 1 ! c 91 of <br />3. Generator's Name and Mailing Address I a mom <br />:x <br />4. Generator's Phone <br />5. Transporter I Comp No <br />7. Transporter 2 Company Name <br />SFIELL OIL COMPANY <br />HI;ZARDOUS WASTE DEPT. <br />P.O. BOR 4848 <br />US EPA ID Number <br />9. Designated Facility Name and Site Address 10. US EPA ID NumberG tState ftu�lNy'# 9DA <br />ERiCKS47N INC, �$ <br />255 PARR BLVD. CAD 0 0 9 4 8 6 3 `3 2 Hcthty,,;=f?ttor €. <br />RTrHmnmn-^ <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers 13. Total 14. Unit <br />al 1t 1 �J.3odwo <br />la 1 t ru sNo. T Quan' Wt/Vol li'i aso: <br />t � <br />I <br />C. <br />d. <br />15. Special Handling Instructions and Additional Information C�tf+ T • t Y/ <br />'h MStsal�a Ti <br />AVOID CONTACT WITH SKIN/EYES SERVICE STATION <br />24 HOUR EMERGENCY PHONE NUMBER (800) 424-9300 880 VICTOR ROAD <br />LORI. Cr,. 952401 <br />Aw <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 are classified, <br />Vpacked, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable federal, state and international laws. <br />JIf I am a large quantity generator, I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be <br />4 economically practicable and that 1 hove selected the practicable method of treatment, storage, or disposal currently available M me which minimizes the present and future <br />N threat to human health and the environment; OR, if I am a small quantity generator, 1 have made a good faith effort to mimn:ize my w,sste generation and select the best <br />waste management method that is available to me and that I can afford. <br />O /TrP� sig //�, Oso BEE -AL1 O� Mamh Dam Year <br />SHELL O I L Cwt. � ®d. ' <br />Z r 17. Transporter 1 Acknowledgement of Receipt of Materials <br />W <br />0 A Pr yped me Sigtatu Month Yeor <br />LUs <br />LU <br />is & <br />Wo <br />P <br />18. Trans r 2 Akkvowled ement of Receipt of Ma <br />W <br />T <br />Printed/Typed Name <br />® <br />a <br />W <br />19. Discrepancy Indication Space <br />V <br />F <br />A <br />Z <br />C <br />I <br />L <br />1 <br />20. Facility Owner or Operator Certification of recei i <br />T <br />Printed/Typed Name <br />Y <br />20444160806+3982 jS <br />DTSC 8022A (12/91) <br />EPA 8700-22 <br />hrdous materials covered by this manifest except as noted in Mem 19. <br />Signature Month Day Year <br />DO NOT WRITE BELOW THIS UNE. <br />Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />To: P.O. Box 400, Sacramento, CA 95812-0400 <br />