Laserfiche WebLink
State of Cclifornic—Environmental Protection Agency <br />Fortn Approved OMB No 2050-0039 {Expires 9-30.99) <br />Please print or tvoe. Form designed for use on elite f 12 -pitch) i,, :writer. <br />1 <br />N <br />a <br />V <br />a <br />OO <br />aL <br />s a <br />J V <br />v <br />N <br />a <br />0 <br />ao <br />W <br />Z <br />,W <br />(i <br />Vim) <br />r Z <br />O <br />I <br />sn <br />Uj <br />`p <br />4W <br />h � <br />�Z� Z <br />V O <br />Z <br />a <br />v <br />0 - <br />Ln <br />O <br />r <br />U <br />Z <br />w <br />V) <br />a <br />V <br />Z <br />See Instruct ons on bock oge 6. <br />LnS's�f <br />Department of Toxic Substances Contr <br />Sacramento, California <br />DO NOT WRITE BELO At THIS LINE. <br />DTSC 8022A 141971 <br />EPA 8700-22 <br />I - Generator's US EPA ID No. <br />Manifest Document No, <br />2. Page 1 <br />Information in the shaded areas <br />UNIFORM HAZARDOUS <br />is not required by Federal law. <br />WASTE MANIFEST <br />CAI 10 10 10 1 111-510 ?41� <br />0 <br /># of <br />3. Generator's Nome and Mailing Address <br />;A $ te�tfesEvm@pEj�iam6er +� <br />L <br />Ro. Nox 6,5w 4 <br />A. Generator's Phone qjZ. <br />` ' .. .: �" a i • "3"'� `'^ "� �'-. <br />5. Transporter I Company Nome 6- US EPA ID Number <br />- <br />`C0%,jrtms�o <br />CONTROL <br />3101117 3 <br />ECOLOGY INDUSTRIES AID9181210 <br />7. Transporter 2 Company Name B. US EPA ID Number <br />.av't_y;?s�i., Rf►�f,�,rv' �•. : 4 .Y..i..r�s.s?�' �.. 3?. ?;rd..vJ"�'}$:5�:�;�:�- <br />9. Designated Facility Nome and Site Address 10. US FPA ID Number0 <br />UP <br />ERICKSON,INC. <br />. <br />255 PARR BLVD <br />' <br />eRICHMOND. <br />CA 9480" tlAlbd 19141 <br />1611011' <br />1 1. US DOT Description (including Proper Shipping Nome, Hazard Class, and ID Number) <br />Containers 13. Total ld. Unit't'si'�' <br />1 Wt/Vol <br />No. Type Quantity <br />a. _. <br />WASTE EMPTY STORAGE TANK PI'P� hc <br />C <br />_.�5-•-•Y7-- • v wy . <br />:. <br />Non-RCRA hazardous waste solid <br />O61110101e <br />6' <br />N <br />E <br />_ <br />R <br />C.�. <br />O <br />R <br />d. <br />:1 <br />15. Special Handling Instructions and Additional Information <br />Zp 57 <br />ear appropriate protective clothing when handling. <br />SITE LOCATION: <br />24 Hour Emergency Telephone Number: 9Zs-Z'7F- '?s'91 <br />24 Hour Emergency Contact: <br />ERG* 171 <br />16. GENERATORS CERTIFICATION: I hereby declare that the contents of this consignment are fully and <br />accurately described above by proper shipping name and are classified, packed, <br />marked, and labeled, and are in all respects in proper condition For transport by highway according <br />to applicable international and national government regulations. <br />if 1 7m a forge quantiy generator, I terrify that I have o pr rum in place to reduce the volume <br />disposal <br />and toxicity of waste generated to the degree I have determined to be economically <br />to the and future threat ro human health <br />practicable and that I hove selected the procticabie method aF treatment, storage, or <br />and he environment; OR, if I am a small quantity generator, I have made o good Faith effort <br />urrently avoilabfe me which minimizes present <br />o minimize my ,vasle generation and select the best waste management method that is <br />available to me and that I can afford. <br />. Printed/Typed Name <br />Signature <br />Month - Day -Year <br />DI 2J b <br />T <br />17, Trons crier 1 Acknowledgement of R ei r of Materials <br />R <br />11 <br />s <br />Printe/Typed Name <br />S u <br />Sig iv r <br />p - <br />Month Day Yeor <br />D' S7 <br />0 <br />18. Trons ower 2 Acknowled emenr of Receipt of Materials <br />T <br />F`6nled/Typed Name <br />Sign torey <br />Month Da Yeor <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />i <br />l <br />20. FQ61ity Owner or Operator Certification of receipt of hazordous moteriols covered by this muni <br />est except as noted in Item 19 <br />T <br />Y <br />Printed/T ped Name C <br />���� CT� <br />Signature <br />A <br />Month Day Year <br />DO NOT WRITE BELO At THIS LINE. <br />DTSC 8022A 141971 <br />EPA 8700-22 <br />