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Slate of California-4feellh and Welfare Agency U J 1y 1 nl 1ctloor.t n r1Dck ,f Page 6 Department ofHeallnsaryces <br /> Form A proved OMB No.2050-0039(Expire$930.91' $04 n' fl O - 9 Toxic Substances Control Division <br /> Please print or type. (Form designed for use on elite 11th typewriter). <br /> and FI-on, of Pat Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Document Manifest 2 Page 1 information In the shaded areas <br /> WASTE MANIFEST C1 At Cl 01 0 0 115121413171 0 0 0 0 1 of 1 Is not required by Federal law. <br /> 3. Generator's Nam p qnd Melling Address A. State Manlfe 1 Document Number <br /> R & B TrucVng $ g 1 g <br /> 1785 N. Corral Hollow Road B. State Generator ato <br /> Tracy, California <br /> a. Generator's Phone(209) 835-6280 <br /> 6. Transporter 1 Company Name 6. US EPA ID Number pTransponef'S <br /> ansporter's ID (7 <br /> n , �, A ry ! 2 ./ ner's Phone <br /> L J <br /> N <br /> 7. Transporter 2 Company Name 8. US EPA ID Number enapophon <br /> q ner's Phone9. Designated Facility Name end Site Address 10. US EPA ID Number acility's ID Erickson, Inc .1255 Parr Blvd. s Ph ln. 235-1393 <br /> Richmond, California 94801 415 <br /> ICIAI D1 1 01 At At Al 11 M 2 <br /> 12. Containers 13. Total 14. 1. <br /> 0 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Ouantlty Unit Waste No. <br /> No. Type WI/Vol <br /> J Slate <br /> a 512 <br /> �U <br /> )Z G Waste Empty Storage Tanks EPA/Other <br /> ) � E California Regulated Waste Only p P None <br /> 3 E T-- State <br /> N R <br /> A EPA/Other <br /> T <br /> a R c. State <br /> EPA/Other <br /> W tl. State <br /> 1- <br /> Z <br /> EPA/Other <br /> U <br /> m J. Additional Descriptions for Materiels Listed Above K. Handling Codes for Waite$Listed Above <br /> O a' eq It. <br /> a <br /> W <br /> W <br /> C. d. <br /> J <br /> Z <br /> Z <br /> O <br /> F 16. 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 pl proper terra io name <br /> � <br /> and are classified.packed,merketl,and labeled,and are In all respects in proper condition for transport by highway according to applicable International and <br /> 4 national government regulations. <br /> N <br /> 0 <br /> If I em a terga economically <br /> practicable <br /> quantity gamble a I that I that I have a program ti place to reduce the volume and toxstorage. <br /> or d of wsale prently available <br /> it the degree 1 have determined <br /> he <br /> O to be economically hre at to u end that I have selected the practicable method of(quantity g storage,or disposal currently faith effort <br /> to me which minimizes the <br /> � present and future threat to human health and the environment;OR,11 I em a smell quantity generator,I have made a good faith ellort to minimize my weals <br /> U generation and select the beet waste management method that is available to me en e 1 ce (lord. <br /> wPrlydedlTyped Name ? Signature Month Day Year <br /> M R o tJ <br /> cRr IL e 131114 W <br /> W T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> Z R <br /> < Arinled/T ed Nem Signator Month Day Year <br /> " J <br /> w0 3 <br /> pl- <br /> P <br /> W O IS. Transporter 2 Acknowledg of ent Receipt of Materiels <br /> U T Printed/Typed Name Signature Month Day Yee, <br /> E <br /> Z_ <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 20. Facility Owner or Operator Certlllcation of receipt of hazardous materiels covered by $m deet except me noted in Item I <br /> 7 <br /> Y Printed�yped IC <br /> Neme Sipnelure Month Day Year <br /> L603 / 6 <br /> DHS 8022 A(I 188) Do Not Write &v4 This Line <br /> \^.' <br /> EPA 8700-22 hife'. TSDr 5[MDS Thll _OPY icl DOHS WITHIN 30 DAYS <br /> (Rev.9-88)Previous editions are obsolete. To: P.O. °rte :1000, ;-;erarnenfn, CA ?5912 <br />