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Fenn Appmwd OMB No.2050-0039(Exp!m 9.30-94) / -vets Instructions on back o% ge 6. D,parrme,,,of Toxic Sabaceco s Control <br /> ease <br /> PlPrim lir type. Form designed for.on elite(12faitcA W. <br /> Sacrmterme,Calilema <br /> UNIFORM HAZARDOUS 1,`Analay's US EPA 10 No. Monifesr Document Nom 2. Page 1 I Inlarmotion m the Faded'rem <br /> WASTE MANIFEST is rot required by Federal law. <br /> CAD98 1 460 .41 5 - 3 0 8 9 ay' T <br /> 3. Genermars ata w mid Mailing Address SHELL OIL COMPANY A-'�ta^a Mmiifnr nomm.t.Namb.e�•y- 'sytgg�[' <br /> h <br /> HAZARDOUS WASTE DEPT. <br /> N P.O. BOX 4848 8 Sbp•Gm ma oy'iHD <br /> m 4. Generarar's Phone (714)520-3312 ANAHEIM CA 92803 Ys H%Q. - 6 1` W, <br /> �1s 5. Transporter 1 Company 6. I <br /> I C:$tonrlrmvpoftet'slDs <br /> tr�nern• re e`x VL 3 .:%!per`% '�' i';Da 7- •'Fe� ?' <br /> r <br /> . D..7rmssporfals' <br /> 7 Tronspoter 2 Company Nams 8. US EPA ID Number rmrsportm'd ID <br /> U E Stme•T ,�c � F <br /> F. Tsompone/sfTa». _.q ;f <br /> 9. Designated Facility Name and Site Address <br /> .iZ 9 M 10. US EPA ID Number ,G. Storm FoaTitys D. - <br /> JOw ERICKSON, INC. * pS: r. :.} , <br /> 'p: e55 PARR BLVD. C A D@ 0 9 4 6 5 3 ? 2 H- <br /> r-dc <br /> FadgysPhme,. et r '.- <br /> AX�510-�33-i39� K <br /> fdca r•G a t �,"�.'��`•a'�+T�,�i` <br /> I1. US DOT Descri tan ncludi P Shipping 12. Cortdtun 10. Tool 14. Unit <br /> Z P (i rg roper PPin9 Name,Hazard Oass,orM ID Number) 'ttn:L_`-'': <br /> WI/Val Wcse:Numbs!'. <br /> E 00 1 TIP O5000 p <br /> p Ecr: <br /> E b. <br /> hr <br /> b A •c-r- <br /> m T <br /> O <br /> W R A/,moi•; t; <br /> Z d. <br /> a .dd'6i osiok�Dva,plsosa fareMabrtab Listed: 'r? <br /> d __ is S lc..NasdFg_rals - - <br /> <r <br /> Z <br /> O 15. Special Handling Instruction,and Additional Information FACIL TY: <br /> ti <br /> Z AVOID CONTACT WITH SKIN/EYES SERVICE 5?A?ION <br /> 24 HOUR EMERGENCY PHONE NUMBER (800) 424-9:,02 880 VICTOR. ROAD <br /> LODI, CA, 95240 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the con ignment am fully and accurately described above by proper shipping rwme and are classified, <br /> Q packed,marked,and labeled,and aro in all respect in proper condition for transport by highway according ro applicable federal,store and international laws. <br /> U <br /> If I am a large quantity gercrmor. I certify Mor 1 fiery,a progrom in place to reduce Me ,olume and toxicity of were generated to Me degree I haw determined tm be <br /> i ec—icaly Practicable and that I haw ulucted the practicable method of rmolment,storage,or disposal currently oVQAable to me which minimizes the pmunt and future <br /> H thntar to human health and the enWonmem; OR, t 1 am a smell quantity generator, I haw mode a good faith effort to ininmaze my wm.e gen--anon and u!ec!the be-* <br /> ac Iwaste mama ement method Mot is aw_flable n me and thor I can afford. <br /> O Pdnmd/Typed Name .�{� s LIN BE:ALF O Month Day Year <br /> 'uIQAL(S SHELL 0`t CO. Y I al 01 31 514 <br /> Z T 17. Trounworter 1 Acknowled entmtr of Receipt of Marerivb <br /> W „ P 4 /Typed Nmne .. <br /> ('J $gttaNr< � PAateh Day Year <br /> 0 1& Trompomer 2 Acknowled ement of Receipt of Materials <br /> u.u. T PHnted/Typed Name <br /> O e Signaluro Month Day Yaar <br /> �++ 19. Discrepancy Indication Spam <br /> H <br /> U F <br /> U A <br /> Z C <br /> I <br /> L <br /> I 20. Fodl' Owrnr or O n r Certificatioof mcm r of hoxardeus materials centered by this manifest except as noted in Item 19. <br /> T Premed/Typed Name <br /> Y Signvtore Month Day Year <br /> 20444-16080E+3982 J6 DO NOT WRITE BELOW THIS LINE. <br /> Nue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> p0 <br /> 2A=(12/91) To: P.O. Boz 400, Sacramento, CA 95812-0400 <br />