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M of Colifamao--Envvonrnewal Protection Agency <br /> rm Approved OMB No 2050-0039(Expires 93494) See Instructions on back of page 6 Deporlmmd of Toxic Substorices Control <br /> se print or type Farm designed for use ori eels(12prich)typeivrrter Sacroniento California <br /> ULRHAZARDOUS 1 Generator's US EPA ID No Manifest Document No 2 Page 1 Information n the shaded areas <br /> / ANIFEST is not required by Federal low <br /> CP; i3 `39 2 4 602 I 5 2@ `3 I of I <br /> 3 Gend Mailing Address SHELL OIL COMPANY <br />' HAZARDOUS WASTE DEPT. ,- <br /> F.t3. BOX 4848 B�+State-Ga,.eofa"r <br /> 4 Gen14}52 r�`3 an ANAHEI!"E CA Sc(903 5 Tranny Namer(:3:C d US EPA ID Number_A ` C Stab T 3D <br /> ' ] D Tratapoftes Phan $ <br /> 7 Transposer 2 Company Name 6 US EPA ID Number E State Transporters ID « <br /> P Transporter s Phase <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number G State Faaliy's IDT <br /> E41Z: SSS <br /> E55 }ORR Fest.D. 1. f :� t 7 /1 u u U H F—My s Phone <br /> jrjN r~ � 3 <br /> 11 US DDT Description(including Proper Shipping Name Hazard Class and ID Number) 12 Cantainen 13 Total 14 Unit » <br /> No T Quant Wt/Vol 1?Wr Nwnber� <br /> LTC ZJ V+ , <br /> G _ <br /> E 4° �' �t rJ (Us 1 7111 <br /> PA t¢ <br /> N b s= �' <br /> E saae a <br /> R 14 ,N az 1 <br /> A a` <br /> T c <br /> R <br /> EFikjCtMter <br /> d ' <br /> Stade". <br /> EPA;[Ofiser - <br /> et <br /> J AddAsonal O tatptsarss for Materials Luted Above K Handing Codes for Wastes Ltsfed}4b°vs ` <br /> a7l:00`I"Y TAW(S) Aft FIBERGLASS/STEEL PIPE a_ <br /> c d <br /> 15 Special Handling Instructions and Additional Information -r 1`` ' <br /> gVOI�i CONTACT WI7N :",__t,, =yw� 1�ft _�E E sP T�=`s <br /> '4 HOUR 01",E RGE114C+ T "=CtN1= r+�MfT E,j ��� riti l- 53i'1( .s1� _. i_}•=5 �' <br /> 15 GENERATOR'S CERTIFICATION I hereby declare that the contents of the consignment are fully and accuratelydescribed above b proper y p per shipping name and are classified <br /> packed marked and labeled and are m all respects m proper condition for transport by highway according to applicable federal state and international laws <br /> If I am a large quantity generator I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be <br /> economically practicable and that 1 have selected the practicable method of treatment storage or dispowl currently available to me which minimizes the present and future <br /> threat to human health and the environment OR if I am a small quantry generator I have made a good faith effort to minimize my waste generation and select the best <br /> waste mono ement method that is available to me and that I can afford <br /> P d/Typed Name <br /> TQ ] re +�' },,_� _t= Month Day Year <br /> ` I T� � ti, Y,i ...7..! Lr�. 0 <br /> T 17 Transporter ) Acknowled ament of Receipt of Materials <br /> APrinted/Typed Name S+ nature <br /> g ) r Month Day Year <br /> L e 1 y <br /> P <br /> Acknowledgement of Receipt of Materials <br /> 0 18 Trans iter 2 <br /> TPrinted/Typed Name Signature Month Day Year <br /> E <br /> A <br /> 19 Discrepancy Indication Space <br /> F <br />�A <br /> C <br /> I <br /> L <br /> 20 FociletvOwner or O erator Cerhficahoo of re t of hazardous matenals covered by this manifest except as noted in Item 19 <br /> Printed/Typed Name Signature Month Day Year <br /> 2044416080E+3r388 JS DO NOT WRITE BELOW THIS LINE <br /> 8022A (t2/91} Blue GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br /> To PO Box 400 Sacramento CA 95812 0400 <br /> 18700--22 <br />