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State of Coli(orma—Environmental Protection Agency <br /> Farm Approved OM8 No.2050-0039(Expires 9-30-991 See Instructions on back oFpp�geS6 Department of Toxic Substances Control <br /> Pleantse piar type. Form designed for use on slim(12-pitch) +iter. .�U Sacramento,Colifarnio <br /> s� neramr's US EPA ID No. Manifest Document t. 2. Pagel Information in the shad ar <br /> deeas <br /> UNIFORM HAZARDOUS s not required by Federal law. <br /> WASTE MANIFEST g L 00 000'{G. t S i ZI 6 °I 1 <br /> 7. Gen amtors Name and Mailing AddrusT� U�/gS Z116 ,*1Sthe Manilesh0ocvmett.Number <br /> --98 4 <br /> o L494; CA - B. State Generator,ID <br /> A4. Usmenscr's PhoneI. ") .3 100 <br /> sell 5. Transporter 1 Company Name a. US EPA ID Number Cl:31ota Transponnr'd ID - - -- <br /> h <br /> m D. Transporter',Phone <br /> DSAN TRANSPORTION L (5101-799-7924 <br /> 8. US EPA ID Number E:;State Transporters ID <br /> 7. Transporter 2 Company Name <br /> i� <br /> � F. Transpoder's Phone ^'�f�` <br /> Q <br /> ry V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. SII F Iliry's ID <br /> PC ERICKSON INC. D 60 6 <br /> 258 PARR BLVD r F I rye ph.�a- <br /> r-IRICHMOND, CA 94801 0 510-235-1393 <br /> C J 12. C. iners � 13. Tara le. U�. , <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Ou°nnry Wt/V I A. Waste:Number <br /> /gLSTE EMPTY STORAGE TANK Stare j,z <br /> cr; c Non-RCRA hazardous waste solid 0 i0iP-Tf3 2 p © O D Q EPA/OmarNONE <br /> E b stow <br /> E EPAJorbl <br /> o R -i <br /> a A sate <br /> 0 Q ;EPA/Other <br /> R _J <br /> YSfate <br /> u d. <br /> � EPAfptke -; <br /> 186atM � t a <br /> L 15. Special HandhngInstructions and Additional Information <br /> ►o ear appropriate protective clothing when handling. SITE LOCATION: <br /> Hour Emergency Telephone Number:209-33'a -` l" 1� "75- 2- 140 <br /> .r <br /> 4 Hour Emergency Contact: c <br /> ERG 171 <br /> 16. GENERATOR'S CERTIFICATION:and <br /> i I hereby all <br /> in pthatthecantenter this <br /> nsportgnmighway according <br /> and ac to amlYdule ibedabove l proper notionppingnameundaratiossi. pocked, <br /> Q marked,and labeled,and ore in all respacH in proper condition For transport Isy highway according m applicable international and national govemmant regulations. <br /> ItersIf I am o large quarth gmmml r,I certify that I have a p ram in place to reduce the volume and toxi<iy of waste generated m the degree I have determined to be economical <br /> N precticahis and that[love selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and Future threat to human heallft <br /> and Om environment;OR,if I am a small quantity generator,I have made a good faits effort to minimize my waste generation and select the best waste management method that is <br /> d' available to me and that I can afford. <br /> - Prinmd/Typed Nama SignaNyb i �Monlh De� Year <br /> ►.z 3 <br /> t„ T 17. Trans iter I Ac nowled amen'of Recei t of Mamrials <br /> 31 prin„d,,,,,d ,� Sign. '. <br /> e D 3 1 2 Iea9 <br /> " /� ' POf cA <br /> P <br /> As <br /> 1110II& 0 78. Transporter 2 Acknowledgement of Receipt of Mamrials <br /> O To Printed/Typed Name Signature Montt Day Year <br /> w [ <br /> A " <br /> 19. Discrepancy Indication Space <br /> L F <br /> A <br /> C <br /> L <br /> ` 1 20. Facili wner Oor O rotor Certification of recei t of hazardeas materials covered 6 this manifest excel t as now in Item 79. <br /> T Prinlwf/Typsd( SignaNF� - — Abnth Day Year <br /> Y 0'E]✓lal.Vs 1A70r//-]',6s'i�' 01 12- 17 17 <br /> DO NOT WRITE BELOW THIS LINE. <br /> r <br /> White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DISC 8022A (4/971 To: P.O. Boz 3000, Sacramento, CA 95812 <br /> EPA 8700-22 <br />