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State of Calif rnla--ieslth and Welfare Agency q5"1-1y see 1n St7Hra{qnR On Cock of PRQe 6 Toxic Substances Control Division <br /> Form Approv d OMB No.2050-0039(Expires 9.30.9 t) and Front of Pnge Sacramento,California <br /> Is so print or type. (Form designed for use on efffe(' :h typewriter). <br /> UNIFORM HAZARDOUS 1.�eralor's US EPA ID No. p M mem t c. Page I information M the shaded areas <br /> WASTE MANIFEST CAC 0 0 0 1 5 2 4 3 7 0 0 3 0l 1 is not required by Federal low. <br /> n I a Ne a nd Melling Address A. State Mantle Document Numher <br /> °� ra� cn 8197148 <br /> 1785 N. Corral Hollow Road <br /> Tracy, California B. Slate Generator's to <br /> 4. Generator's Phone 1209 ) 835-6280 <br /> n 6. Transporter 1 Company Name 8. US EPA ID N mbar C. Stale Tranaporter'e ID <br /> A 6 7 D. Treneponar'a Phone d 9 <br /> N <br /> Gi <br /> 7. Transporter 2 Company Name e. US EPA to Number E. Stele Traneponer'a 113 <br /> gI I I I I I I I I I F. Transporter's Phone <br /> m <br /> B. Designated Facility Name and Site Address 10. US EPA ID Number O. Stele Facility's ID <br /> J Erickson, Inc. <br /> Oa 255 Parr Blvd. H. Facility's PIne <br /> f Richmond, California 94801 15 235-1393 <br /> 1Z ICAD 10 10 19 14 16 16 3 19 12 <br /> 12, Containers 13. Total 14. I. <br /> -,0 I1. US DOT Description(Including Proper Shipping Name,Hazard Claes,and ID Number) Quantity Unit Wal No. <br /> J No. Type Wt/Vol <br /> w a. stele 512 <br /> DZ G Waste Empty Storage Tanks -� EPA/Other <br /> ) 3 N California Regulated Waste Only d p T i None <br /> E b. Slate <br /> R <br /> A <br /> T EPA/Other <br /> v 0 <br /> a R C. Stale <br /> 8 <br /> m <br /> EPA/Other <br /> W d. State <br /> 1- <br /> Z <br /> w <br /> (� EPA/Other <br /> W <br /> 0 J. Additional Descriptions for Materiels Listed Above K. Handling Codes for Wastes Listed Above <br /> 0 a. b. <br /> a <br /> N <br /> W <br /> C. e. <br /> J <br /> Z <br /> Z <br /> Q <br /> 16. Special Handling Inetructlons and Additional Information <br /> Z <br /> w <br /> J <br /> J <br /> � 1e. <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,packed,marked,and labeled,and are In all respects In proper condition for transport by highway according to applicable International end <br /> national government regulations. <br /> 2 II 1 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 /> 0 to be economically practicable and that I have selected the practicable method or treatment,storage,or disposal currently available to me which minimizes the <br /> ? present and future threat to human health and the environment;OR,If I am a smell quantity generator.I have made a good faith effort to minimize my waste <br /> 0 generation and select the beat waste management method that Is available to me at I n afford. <br /> Z <br /> w Printed/Typed Name Signature Month Day Year <br /> (7 <br /> IF <br /> WT 17. Transporter 1 Acknowledgement of Receipt of Materiels <br /> R41 <br /> Q A Printed/ p Name Signator Month Day Year <br /> N <br /> 0 P V <br /> W 0 18. Irronsporter 2 Acknowledgement of Receipt of Materials <br /> U R Printed/Typed Name Signature Month Day Year <br /> E <br /> Z <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered 19"18 <br /> nifeet except as noted In Ilam <br /> T <br /> y Printed/Typed Nems 3lpnalur Month Dey Ye <br /> 68 <br /> DHS 8022 A(1/88) Do Not Write -Be-row This Line <br /> EPA 8700-22 Wllite: TSDFSF IS 'OPY TO DOHS WITHIN 30 DAYS <br /> (Rev.9-88)Previous editions ere obsolete. To: P.O. Pox 3000, Sncramcnto, CA 9312 <br />