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Stoll of Cal,fomia—Emnron"ieritol Ptatectmo Agency <br /> Form Approved OMB No 2050-0039(Expires 93094) See Instructions on back of page b Departmersl of Toxic Substances Control <br /> Please Fine or type Farm d"Vned For use on&fife(12-pitch)"Writer Sacramento Colhfornw <br /> UNIFORM HAZARDOUS I Generators US EPA ID No Manifest Document No 2 Page 1 Information m the shaded areas <br /> u not required by Federal kaw <br /> WASTE MANIFEST <br /> r^ A D 9 8 i ff . c 1 `1 aI <br /> 3 Generators Name and Mailing Address <br /> SHELL OIL COMPANY ;A51uFe Dort;meat ^,ti <br /> HAZnRDOUS :BASTE DEPT, <br /> �� rd <br /> P.D_ BOX x+848 s-sial&cetterata�suo� <br /> 4 Generator s Phone (. )c ;+^ mnHEim. qn <br /> Comp <br /> r j <br /> 5 Transporter 1 any Name d US EPA ID Number C State n'aafQ--S- <br /> � 4 <br /> CROSBY $ OVERTON. 1 N C. A D D Trce"partets,ftems� <br /> Q 7 Transporter 2 Company Name B US EPA ID Number I? State Transporters ID Y <br /> J <br /> F Transporters Phone s ti m <br /> 9 Designated Faulty Nome and Site Address 10 US EPA ID Number G State FaraWs ID '1',:;4, , - <br /> R0111C L.i+4ViRONVENTi'L I I I I I rt <br /> L 2081 A 1 4ORD r � 'n �T G � - t - - H Faaley's Phone <br /> r *t+ <br /> nl rFt C�`a - - - <br /> 11 US DOT Description(including Proper Shipping Name Hazard Class and ID Number) 12 Containers 13 Total 14 Unit <br />_ No T an Wt/Vol I Wm*Number <br /> u. v+ !� = .L t .�. Stall 134 <br /> ii i J�.Sr i 007561t� ` <br /> Tr EPA/Offter <br /> s i <br /> tZ E N b State, <br /> E <br /> R EPA/01h" <br /> A <br /> T c stale <br /> O <br /> R EPA/Other <br /> i� <br /> d State <br /> L <br /> J <br /> EPA/011ier <br /> J Adclatonal Descrsphons for Matenals luted Above K_ Handling Codes for Woos listed Above <br /> n :RINMTE IGNITABLE FLASH (140F, BENZENE )0.5 PPM a b <br /> L <br /> c d <br /> 15 Special Handling Instructions and Additional Information t } r <br /> VOID C0r'qTA'L'11,- W:-- <br /> 2/f �A,!!L'UR LM.`-RS- NC ' ,L^� ",L',BEP 1500 � I �tA1' LF30 t ,�ilio -i-1111D <br /> L rr' `IMM 1 E �{ h) EC a,T rly.�`t [��tS Y �, -c , r -T �`.s4i` <br /> "tl '1�'l. L �..`f � r..� \-.( ..! Lr �'�1 TLti <br /> 16 GENERATOR S CERTIFICATION I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified <br /> packed marked and labeled and are lin all respects,n proper condition for transport by highway according to applicable federal state and international taws <br /> If I am a large quantity generator I certify that I have a program lin place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> J economically practicable and that I have selected the practicable method of treatment storage or disposal currently available to me which minimizes the present and future <br /> threat to human health and the environment OR d 1 am a %mail quantity generator 1 have made a good faith effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that I can afford y <br /> Month Day Year <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> Prt /Typed Name Sig Month Day Year <br /> N Ic1f,� r �l L ,- o Z Y <br /> �_ <br /> 0 18 Transporter 2 Acknowledgement of R e, t of Materials <br /> Ll a Panted/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19 Discrepancy Indication Space <br /> n <br /> S F <br /> A <br /> C <br /> 20 Facility Owner or Operator Certification of receipt of hazardous motenols covered by this manifest except as noted in Item 19 <br /> Printed/Typed Name Signature Month Day Year <br /> 20444160806+396" 175 DO NOT WRITE BELOW THIS LINE <br /> 12/91 Blue GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br /> SC 8022A ( ) To P O Box 400 Sacramento CA 95812 0400 <br /> A 8700-22 <br />