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Slate of California--Health and Welfare Agency Department of Heellr <br /> Form Approved OMB No.2050--0039(Expires 930 1� Toxic Substances Color,;.D—s <br /> DIMa print or type. (Form designed for use on all. 2 pitch typewriter). G/ Sacramento.Caldor <br /> UNIFORM HAZARDOUS L Generate( US EPA ID No. Manifest 2 Page 1 Information in the shaded areas <br /> WASTE MANIFEST CAD 9 6101819131515161 ODo�uma1 0 1 1 1 <br /> of ie not required by Federal law. <br /> 3. Generetoi s Name and Meiling Address A. State Manifest Docum",Number <br /> MANl'EXA UNIFIED SCHOOL DIST. _, i i U , <br /> 72901 E. LOUISE AVENUE B. Slate Generator's ID ` <br /> a. enTiF,erT aHto�i aPPfiane 7A. ) 95330 <br /> .N 5. Transporter 1 Company Name e. US EPA ID Number C. Slate Transponer's ID C O 1 11 <br /> e ERICKSON TRUCKING INC. CAD 0 0191 41616 3 19 12 D. Transporter's Phone 235-1393 <br /> N <br /> M 1. Transporter 2 Company Name e. US EPA ID Number E. Stale Transporter's ID <br /> m <br /> 8 F. Transporter's Phone <br /> m <br /> 9. Designated Facility Name and Site Address 10. Us EPA ID Number G. Stab Facility's ID <br /> ERICKSON INC. IOJ 111 pion 1919 1 fi l 4 t9 if 17 <br /> < 255 PARR BLVD. <br /> U H. Facility's Poona <br /> < RICHMOND, CA. 94801 CAD 0 0 9 4 6 6 31912 (415) 235-1393 <br /> 1O 12. Containers 13. Total u. 1. <br /> w I1. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Waste No <br /> No. I Type WI/Val <br /> Q <br /> a state <br /> WASTE, EMPTY STORAGE TANK <br /> Z 512 <br /> t E CALIFORNIA REGULATED WASTE ONLY. EPA/Olher <br /> N OO1TIP 00950LBS NONE <br /> E b. <br /> Slate <br /> N R <br /> A <br /> T EPA/Other <br /> N 0 <br /> e R c. <br /> g Stab <br /> m <br /> EPAIOIhar <br /> w d <br /> F State <br /> Z <br /> W <br /> U EPA/Other <br /> W <br /> 2 J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> a 1 — EMPTY LEADED GASOIME TANK NO. 2-B80 n/ b. <br /> a ICED WITH 15 LBS DRY ICE PER 1,000 (J <br /> GALLONS SJCEHD # 1958-01 ° <br /> Z <br /> 0 <br /> H 15. Spacial Handling Instructions and Additional Information <br /> 2 <br /> w <br /> J <br /> J <br /> Q 18 <br /> V <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 and are classified.pecked,marked.and labeled,and ere in all respects in proper condition for transport by highway according to applicable international arc <br /> national government reguletiona. <br /> It I am a large quantity generator,I codify that l have a program in place to reduce the volume and toxicity of waste generated to the degree I have datarm,ree <br /> U to be economically practicable and that I have selected the practicable method of treatment, storage,or disposal currently available to me which minimizes ne <br /> present and future threat to human health and the environment;011,it I am a small quantity generator,I have made a good faith effort to minimize my waste <br /> U generation and select the best waste management method that is available to me and that I can afford. <br /> Z <br /> w Printed/Typed Name <br /> V+ signature Month Day Yur <br /> r S <br /> WA 1011 Lgl!�l To <br /> W T fir. Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A Printed/ ped Name u <br /> Q N signal Monro Day year <br /> o s lo {' Uoy a <br /> W O I8. Transporter 2 Acknowledgement of Receipt of Materials <br /> m <br /> R Printed/Typed Name Signature Month Day Year <br /> U E <br /> Z_ <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. FacilityOwner or Operator Certification of receipt of hazardous materiels covered is manifest except as noted in It 19. <br /> T <br /> y <br /> Plitt d/ ped Nama Sipnelu Monty Day you <br /> q o <br /> DHS 8022 A(1/88) Do Not W its Below This Line <br /> EPA 8100-22 <br /> (Rev.988)Previous editions are obsolete. <br />