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Stem of C-ifomks--E—'-n d Pmsec,ion Agency <br /> Form Approsed OMB No.20:0-0039(E,.9.30-9qI $Ce Instructions on back of� - S. <br /> Fseom odes or type. Foran designed far asci on eMa 02pir A)ryp. Department of roaic Subasevs earmd <br /> scorn eea.ceiRcrs:a <br /> UNIFORM HAZARDOUS I. Generator's US EPA ID No. Monfort Doansnt No, 2, Page I lefannoson in the showed areas <br /> WASTE MANIFEST I <br /> is not regsired by Fads law. <br /> C g ID 19 18 11 14 16 10 12 11 15 2 1 31 0 1 8 1 8 f <br /> 3. Generator's Norma and Mailing Address >; -- <br /> � SHELL OIL COMPANY AblffatfDwniiisesNNienberi+q(��,`� _ <br /> HAZARDOUS WASTE DEPT, � <br /> v <br /> P.O. BOX 4848 s*..cfmte a.ar�nD" <br /> Dm <br /> A. Generator's Phone 1 yy S^ _ _ t <br /> Y y <br /> F ) 3 <br /> j3. Transports 1 Company Nome 6. US EPA ID Numbor 'C.Stioe*TFantpoderrs� ` <br /> CROSBY & OVERTON, INC. 9 8 2 5 4 4 9 0 D4Tm epr erx m <br /> Q7. Transporter 2 Company Name 8. US EPA ID Number E.Sate;Tranpo ser-ssl _ - <br /> JIM <br /> 5; 9. Designated Facility Name and Site Address 10. US EPA ID Number I"u,$sah S.1 <br /> j ROMIC ENVIRONMENTAL r, �> <br /> 2081 BAY ROAD CgD0R94S 557 <br /> k4 hwr cPhanwk Y <br /> = a °✓ 1� 4-1638;• 'Z• <br /> 11. US DOT Description(including Pmper Shipping Name,Hazard Clan,and ID Number( 12. Containers 13. Total 14. WN <br /> Wt/Vol :U.W- WW !fizV <br /> L'N 1993, I V p <br /> G (D001) , (D018) 0 0 T A/ _ <br /> 1s. E I T s @01 <br /> > N It. <br /> R <br /> � T <. <br /> O 'r <br /> R <br /> d. Ll I <br /> A <br /> `aX•AAdJvwlz"a ipho s far Motenalslhted Abosw Wages(seed Above sat ~gf`;. <br /> i1="I6NITRBt �)8 5i RW a b" VSs <br /> ,rd,. .ux <br /> eFr.�a '; •.'7�x�r,':2„X. .�WIT <br /> i 15. Special Handling Irntrucaons and Additional Information FAC`7 L T r <br /> AVOID CONTACT 1411H EYES/SKIN SERVICE STATION <br /> 24 HOUR EMERSENCY PHONE NUMBER (800) 421-3300 888 VICTOR ROAD <br /> FLAMMABLE PLgCARD REF UN1993 PROFILE 4 013425 L.ODI. CA. 95242 <br /> 16. O@IERATOR'S CERTInC'ATION: I hereby declam that the comwas of the consignment am fully and accurately desexibed above by proper shipping.me and am classified, <br /> pocked,marked,and labeled,and aro in all respect;in proper condition for transport by highway according to applicable federal,date and international laws, <br /> If I am a large Rwafty generator, I certify that 1 hove o program in place to reduce the volume and toxicity of waste generated to she degree I have determined to be <br /> ecoramwall,practicable and that 1 have selected the practicabN em <br /> method of heatrn ,storage,or disposal currently available to me which minimizes the prasenr and fuNre <br /> threat to hum. health and she emirassent;OR,8 1 am a smc"quantity generator,I have made a good faith effort to mmimim my worst,generan tioand sekM the best <br /> waste monagenseen method <br /> .that is available to me and that I can afford '. <br /> Typed Na e •�-.c'�. _ <br /> S. rat ,n.,N ['•E.'�ALF OF Month Day Year <br /> SHP1L OIL CO. <br /> T 17. TrempsImar 1 Acknowkd omen of Receipt of Materials <br /> e <br /> A Pd /TYW'd/Plante S. <br /> N <br /> I C 1� n i't c/ I��- h!a^th Day Year , <br /> • - o Z � <br /> 0 18. T r 2 Ack.wled merat R of Matadoh <br /> r Preand/Typed Name <br /> s Siq.Nm Month Day Year <br /> e <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> I <br /> r20:1m,]T�6 —or r Certifican.of rete! t of hazardous mammals covered b this manifest exce t as nomd in Itm 19. <br /> T med/ yped Name Sial a month pay Year <br /> 20444160806+3962 JG DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> SMA Ili/9p To: P.O. Box 400, Sacramento, CA 93812-0400 <br /> 8]00-22 ' <br />