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1 I Slate of Cdllomla—Hamnin and Welfare Agency Department of Health Sr. <br /> Form Approved OMB No.2060�p3g(Expires'' 9q L2LE-7— <br /> [4 §� <br /> Toxic Substances Control Cl lease print or type. (Form designed for use c e(12pilch typewriter). Sacramento.Cali 1. Generator's US EPA ID No.UNIFORM HAZARDOUS Page nformation In Na shaded areas <br /> WASTE MANIFEST CA0 of not required by Federal law <br /> enerator's Name and Mailin Address A. State Manifest Ogcu(aent�rTOCKTON TRI II9USTRIES p <br /> 141 ANDERSON STREET' J " 'J i 1 `Q 4 <br /> CA. 95205Generaton r o s rine( ) _hraseporlar 1 Company Name B. US EPA ID Number C. State Tnneporler's ID v> ( f <br /> INC. CAD 0 0 9 4 6 6 3 9 2 p (415) 235-1393 <br /> ERICKSON TRUCKING D. Transporter's Phone <br /> m 7. Transporter 2 Company Name 8, US EPA ID Number E. Slate Transporter's ID <br /> g 1 1 1 1 1 1 F. Transporleis Phone <br /> p. Designated Facility Name and Sill Address 10. US EPA ID Number G. Slate Facility's ID <br /> ERICKSON INC. C Ifs paDL91'��!1121g i9 iz; <br /> v 255 PARR BLVD, H. Fame ! Phone <br /> Z <br /> RICHMOND, CA. 94801 CjAj DI 0101 91 41616 3 9 2 (415) 235-1393 <br /> 11. US DOT Description(including Proper Shipping <br /> Q. Containers 13. Total 14 I. <br /> g P ppin Name,Hazard Class,and ID Number) Quantity Unit Waste No. <br /> < a. <br /> N . <br /> Type Wt/Vol <br /> = G WASTE, sfP-J Y STORAGE TANK State 512 <br /> E CALIFORNIA REGULATED WASTE ONLYE1110l <br /> E b. 0 0 1 T P 003 501bs NONE <br /> m R Stale <br /> A <br /> m T <br /> V O EPAlpther <br /> N <br /> 8 Slate <br /> m <br /> EPA/Other <br /> w a. <br /> z State <br /> w <br /> U <br /> w EPA/Other <br /> Z J. Additional Descriptions for Materials'..'so Above K. Handling Codes for Waslu Llsled Abgva <br /> O <br /> W 1 — EMPTY LEADED GASOLINE TANK NO. a. O, b. <br /> ¢ ICED WITH 15 LBS. DRY ICE PER 1,000 GALUJN c. d. <br /> `z CAPACITY. STCEM #1011-01 <br /> 0 <br /> 1— 15. Special Handling IOetreOL-rte and Additional Information <br /> Z <br /> w <br /> J <br /> J <br /> U <br /> 18. <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> J end are Classified,Packed.marked,and labeled,antl are in all respects in proper condition for transport by highway according to applicable international and <br /> d national government regulations. <br /> N <br /> O¢ 111 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 <br /> to be economically practicable and that have selected the practicable method of treatment, storage,or disposal currently available to me which minimizes the <br /> > present and future throat to human health and the environment;OR,it I em a smell quantity nerolor,I have a e good faith effort to minimize my waste <br /> U generation and select the best waste management method that is available to mal and That n afford. <br /> 2 <br /> w Printed/T m' <br /> U / Signature Montn Oq Yav <br /> fl+ IYI f Czt +� ZFw RT =eEPZ <br /> er I knoWledpamenl of Receipt orMaterialsA Ne eN7 /� Signature Sy R7 -C I, t I\ (ttG� Mpnlh Dar Yez <br /> w p r 2 Acknowledpemant of gecaipl of Materiels B Name2 ESignatureMonth Dar Ye_. pcy��Indication Space <br /> F 31 Z):7_ Ce .l­r)riC <br /> A <br /> C <br /> I <br /> L <br /> 20. FAcilil Owner or Operator Certification of receipt of hazardous materials cover this manifest except as noted in It 8. <br /> y Print T pad Name Signal <br /> GN Month Do, Ye. <br /> U j I j Z."j <br /> DHS 8700 A IBB) <br /> EPA 870o-�-22Do Not W ow This Line <br /> (Rev.9 88)Previous editions are obsolete. <br />