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State of Colifomio—Emironmmk4 Protection Agency <br />Form Approved OMS No. 2050-0039 (Expires 9-30.94) <br />Please prim or type. Form designed for use on effro (12 <br />UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />3. Generators Name and Mailing Address <br />in <br />an <br />1\ <br />in <br />00 <br />9 <br />00 <br />J <br />J <br />Q <br />U <br />See Instrudions on ba ge 6. <br />pewMer. <br />I. Generator's US EPA 1D No. Manifest Document No. <br />SHELL. OIL COMPANY <br />HAZARDOUS WASTE DEFT. <br />a.O. BOX 4848 <br />4. Generator's Phone (714)520--3312 AREAr°q <br />5. Trmer 1 :�[�Yl Nny Name <br />7. Transporter 2 Company Name S. US EPA ID Number <br />Z 9. Designated Facility Name and Site Address 10. US EPA ID Number <br />(\j 0 ER I CKSON, INC. <br />LJ5PARR BLVD. CAD00946G39 <br />U a qt 4 <br />Z 11. US DOT Description (including Proper Shipping Name, Hazard Clens, and ID Number) 12 <br />=Nr <br />N 1- r 1?r v, = t S <br />O 15. Special Handling Instructions and Additional Information <br />Z AVOID CONTACT WITH SKIN/EYES <br />U.1 24 HOUR EMERGENCY PHONE NUMBER (600) 424-9300 <br />b - <br />J <br />N <br />Department of Toxic Substances Com. <br />Socramento, California <br />2. Page 1 I womialian in the shaded areas <br />is not required by Federal law. <br />of <br />13. Total 1 14. Unit <br />FACILITY: <br />SERVICE STATION <br />880 VICTOR ROAD <br />P <br />Q <br />16. GENIERATOR'S CERTIFICATION: 1 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 to federal, <br />v®� <br />GS <br />according applicable state and international laws. <br />o <br />E <br />If I am a large quantity generator, I certify that I have a program in place to reduce Hee vokmili and toxicity of waste generated to the degree I have determined to be <br />economically practicable and that 1 have selected the practicable method of treatmem, storage, or disposal currently available to me which minimizes the present and future <br />00 <br />N <br />b. <br />E <br />waste in ement method that is available to me and that I ran afford. <br />v <br />1 <br />R <br />h d/TxPed Name <br />j. t N BE -HALF OF MonthfYear <br />b. ca -f/ 1�7 f/``� SHELL J 3 L CO. / <br />d <br />A <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />(� <br />LU <br />T <br />C. <br />00 <br />r <br />O <br />18. Transporter 2 Ack owled ement of Receipt of Materials <br />U.O <br />R <br />Printed/Typed Name <br />U.1 <br />Month Day Year <br />t - <br />Z <br />d. <br />U.1 <br />N <br />U <br />UF <br />A <br />w <br />Z <br />C <br />I <br />H <br />L <br />ot` <br />d 'tionul., scrlptions for m <br />20. Facili Owner or rotor Certification of recei t of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />w <br />Day Year <br />20444160806+3982 3G DO NOT WRITE BELOW THIS LINE. <br />Ix <br />EPA 8700-22 <br />Z <br />O 15. Special Handling Instructions and Additional Information <br />Z AVOID CONTACT WITH SKIN/EYES <br />U.1 24 HOUR EMERGENCY PHONE NUMBER (600) 424-9300 <br />b - <br />J <br />N <br />Department of Toxic Substances Com. <br />Socramento, California <br />2. Page 1 I womialian in the shaded areas <br />is not required by Federal law. <br />of <br />13. Total 1 14. Unit <br />FACILITY: <br />SERVICE STATION <br />880 VICTOR ROAD <br />P <br />Q <br />16. GENIERATOR'S CERTIFICATION: 1 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 to federal, <br />U <br />according applicable state and international laws. <br />CL <br />If I am a large quantity generator, I certify that I have a program in place to reduce Hee vokmili and toxicity of waste generated to the degree I have determined to be <br />economically practicable and that 1 have selected the practicable method of treatmem, storage, or disposal currently available to me which minimizes the present and future <br />N <br />threat to human health and the environment; OR, if 1 am a small quantity generator, I have made a gocd faith effort to -oinimize my waste generation and select the best ' <br />waste in ement method that is available to me and that I ran afford. <br />O <br />u <br />h d/TxPed Name <br />j. t N BE -HALF OF MonthfYear <br />b. ca -f/ 1�7 f/``� SHELL J 3 L CO. / <br />Z <br />LLJ <br />T <br />It <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />(� <br />LU <br />A <br />Year <br />TWZ <br />ui <br />18. Transporter 2 Ack owled ement of Receipt of Materials <br />U.O <br />T <br />R <br />Printed/Typed Name <br />Month Day Year <br />N <br />19. Discrepanry Indication Space <br />UF <br />A <br />Z <br />C <br />I <br />L <br />1 <br />20. Facili Owner or rotor Certification of recei t of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />Printed/Typed Name <br />ame SignatureMonth <br />Day Year <br />20444160806+3982 3G DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (12/91) Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />To: P.O. Box 400, Sacramento, CA 95812-0400 <br />EPA 8700-22 <br />