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Form Apprewd OMB No.2050-0039(Expern 9.3694) See Instructions on boc4 age 6. Department of Tock Substances Com <br /> Pleme pnm� type. Form daigmd Ivo use on ohm(12174 ..,ter. Sac,a„a,a.C.Momea <br /> UNIFORM HAZARDOUS 'eA -.r',US EPA 10 No. Manife h vmem 2- Page I Information in the horded arum <br /> n norequired by Federal law. <br /> WASTE MANIFEST r1,318 R D ' 4 6 0 0 ' 5 0 0 o p of 1 <br /> t7 3. Generatord M <br /> ,Name anaiP g Add., y SHELL OIL COMPANYell <br /> s <br /> ' HAZARDOUS WASTE DEPT. "- '"'P <br /> N <br /> P.O. BOX 4848 c eaaarrlD. <br /> n a. Genermor':Ph— 1 4) 20_x:,12 ANAHEIM CA 92803 <br /> rS s. Trysgytx I airy NaT� Li. T � <br /> V7. Tromponer 2 Company Marne S. US EPA ID Number <br /> Q <br /> r�Z 9. Designated Facility Name and Site Add. 10. US EPA ID Number Fad i1DiLat - <br /> nJp ERICKSON, INC. . ,. <br /> CV!�: 255 PARR BLVD. C A D 0 0 9 4 6 6 3 9 c wxFbaTy: ` 339 g <br /> c*uPTrwmnHn 70 as <br /> Z 11. US DOT Description(including Pnaper Shipping Nome,Hazard Clens,and ID Number) 12. Conem en 13. Total I4 Unit <br /> �� , _ , h L a_ ., �` . 1 No. T "/Vol 1. Wastc.Nwnba <br /> 3 <br /> A�o f 0 0 1 TIP18 a 0 0 P EEA <br /> m N It.go <br /> a_ <br /> v E . <br /> e R „A/.Ohre <br /> d A : <br /> WO T r' .5lataa; <br /> z R 'EPA/glie' <br /> Z d. <br /> V <br /> W EPAfOHmr" "' <br /> 8'd'a°l72" <br /> Z J Add nonal Desaipriom to,Morenals Limed Above PC Handfug Coder for Waam lutea Abe.e <br /> a EMPTY TANK(S) AND FIBERGLASS/STEEL ="u` <br /> 6„ •_ <br /> c <br /> Z <br /> Q 75. Spatial Halling Instructions ad Additional Information <br /> FACILIT'f: <br /> Z AVOID CONTACT WITH SKIN/EYES SERVICE STATION <br /> 24 HOUR EMERGENCY PHONE NUMBER (600) 424-9300 880 VICTOR ROAD <br /> LODI CA. 95240 <br /> 16. GENERATOR'S CERTIFICATION: I hereby decla a than Me comems of the consignment are fully and accurately described abow by proper shipping name and are classified, <br /> Q packed,marked,and labeled,and arc in a8 respects in proper cardition for transport by highway according to applkoble federal,state and imematiorwl bas. <br /> U <br /> If I am a large quantity gamranor. I terrify that I how a program in place no reduce the volume and toxicity of want generated to the degree I haw determined to he <br /> 1 ecoramkoly practicable and that I haw selected tlse practicable method of neanmert,storage,or disposol currently available ro me which minmizm the present and future <br /> y threat to human health and the mHrorwem;OR, if I am a small Wareky generator, I haw made a 9«d faith effort ro -animize my waaagene or on and select the bear <br /> ornate management method that is avoilable to nh and that I can afford- <br /> 0 (""(.'/TXped Name 5i CN B-HP[F OF pmt Year <br /> bLk7A- I�r� �" SN <br /> ELL OIL CO. / 5 <br /> Z T 17. Transporter 1 Acknawled emert of Receipt of Materials <br /> w e <br /> wLJ Pryoyd/Ty� 'g- •w, 1� Si / <br /> 5 <br /> e <br /> o I8. Tann r 2 Ack wled mmrr of Recei r of Materiak <br /> w i Printed/Typed Name <br /> IF <br /> tl a SignaNre Morph Day Yeor <br /> Q <br /> w 19. Discrepancy Indication Space <br /> N <br /> Q F <br /> V <br /> ZLA <br /> 20. Foadi wneOr or O roor riCernficaon of r« of hazardous materials covered b this manifmr exce r m noted in tem 19. <br /> Primed/Typed Name SignoNreMeeh Day Yeo, <br /> I <br /> 20444160806+1-982 JG DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A (12/91) To: P.O. Baz 400, Sacramento, CA 95812-0400 <br /> EPA 8700-22 <br />