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Store al Caldomio rntarmmml Protection Agensy <br /> Form Approved OMB No.1050-0039(Expires 9aa94) See Instructions on back of 6. Dep>enmo of To..sabstmees Cental <br /> Pkore prwt or type. Form de imeaf far uv on elite/1190 sovvnomo.Colifomla <br /> UNIFORM HAZARDOUS 1' Gen•abrs US EPA ID W. Mm last Doeu err Na 2. Page 1 Informo m in the shaded a,s <br /> WASTE MANIFEST is nor``wired by Federal law. <br /> I-- 1 / C 7 o d I. <br /> Ct3. (xnermarr Noma and Mailing Address SHELL OIL COMPANY '-' - <br /> h <br /> HAZARDOUS WASTE DEPT. r�:_V <br /> n <br /> 0.0. 80\ 4848 Soo.sbeIii.- °r"°` x ` <br /> 4. Demeanors Phase (7 t )c-sA-3' 7 M u _ V -rabJ <br /> 3 S. TrassporM 7 Com Name 4J1' FRA)Q I.lymba C Sble•TepreparMs;1D° L <br /> o _ °�-Tfl� t-1_IJU 9GG3� .:�..��•.. <br /> ms's'-Tea — D. TivepwMsrPlswr. <br /> G7. Transporter 2 Company Name 8. US EPA ID Number, E..State Trmnporeels ID✓ y- i �{f <br /> U v.�,.:iMLY++'s%TY?!dRz`"5 K3tar:- •e�P...dP. <br /> F ,4rrrMpprMssPAass- _ ,r <br /> Z9. Dedgtatad Fedlity Nome and She Address 10. US EPA ID Number G SStara.FasIW_&ID its. 1 <br /> 0 ERICKSON, INC. <br /> 255 PARR BLVD. C A D 0 0 3 4 6 6 3 9 2 " yam'✓'"' "r�=5i0-23 1393: <br /> I1. US DOT Oestri ncluis Pro Shipping Nome,Hazard Cass,and ID Number) 12. C.Epiners 13. Totel 14. Ilnir Yr';yy�i�yy" '. <br /> Z Description(1 ^9 Per PPi^9 No. T WI/Yd �1:.,Waste Numbs . <br /> = aNUN—KI-INR t. <br /> r. - <br /> E 0 0 1 TIP 5 0 0 0 P .EPA/OMer' <br /> A N b. <br /> E �= <br /> p R EPA/OIh r" <br /> j A S R <br /> u <br /> �— <br /> j .'s19l�Qc, � <br /> u EPA�OMacc <br /> n <br /> JiiAdd:haol Desmprvn far Mamrwls Listed Above >'w,y,To- K HmtdlM9 Caps la WnMu Us1sd,Abbvr.. <br /> n PTY TANK(S) AND FIBER&LRSSISTM °PIPE`T o-^� a kms : {••+, b <br /> uAs- <br /> e <br /> J_ 5). ^ T J J ...�T - L'..• } C d } 4 -rut tC <br /> 15. Special Handling Instr lima and Additional Information FRCILITYA. - <br /> S AVOID CONTACT WITH SKIN/EYES SERVICE STATION <br /> 24 HOUR EMERGENCY PHONE NUMBER (300) 424-9300 3881 VICTOR ROAD <br /> LODI. Com. 952414 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully arid acarrarely described oboe by proper shipping tame and are sl..fied, <br /> C packed,marked,and labeled,and arc in all respec in props candilion for transport by highway according no applicable federal,state sed international Ima. <br /> 1 <br /> If I am a large Iamr, generator, I certify Mor 1 have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have demmtkied to be <br /> economically procticable and that I have selected the praclicable,method of mommertr, manage,or disposal currandy a sulablo to me which rninieizes the present and fume <br /> j Mai to human heahh and the environment; OR, if I am a small gponety generaor, I have made a good falYt effort to miner¢`my-. generation and seien the best <br /> waste management me bod that is a.aiiable to me and that I can afford. <br /> i �/Typed No Si ON BEHALF OF Ma+6 yea <br /> �'`�Q /� SHELL OIL CO. <br /> T 17. Transporter 1 Acknowled emenl of Rei of Materials fill <br /> =,4v ' <br /> o I8. Tro 2 krowled emeM of Receipt of Materials l <br /> t <br /> Printed/Typed Name Sgmture Month pay Year <br /> • <br /> 19. Diurepmrcy Indication Space <br /> F <br /> A <br /> C <br /> 1 <br /> L <br /> I TQ Fa51' IDwr:er or Operator Certification,of ret i t of hazardous materials covrod b Mla manifest exce t a noted in Item 19. <br /> T Printed/Typed Narrse Si'mm re Month Day Year <br /> Y <br /> 20444160806+30182 JS DO NOT WRITE BELOW THIS LINE. <br /> TSC 8022A (17/91) Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> rA 870 22 To: P.O. Boz 400, Sacramento, CA 95812-0400 <br />