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State of Cahlorrra--Envirpnmentai Protection Agency <br /> Form Approved OMB No 2050-0039(Expires 9 3494) See Instructions on back of page b Dapartmenf of TOXK Substances Control <br /> Please print or type form designed for use on side f f2-pdch)rypewnftr Socrainer" Calrforriia <br /> UNIFORM HAZARDOUS 1 Generator s US EPA ID No Manifest Document No 2 Page I Information m the shaded a— <br /> rs riot required by Federal law <br /> WASTE MANIFEST r - of <br /> / c i ❑ <br /> 3 Generatar s Nome and Maoiing Address ����� U IL COMPANY A State Mamfvenst Doamterd N urnber�- J <br /> T <br /> H C;ZPRDOUS WPSTE DEPT. � �C77 <br /> . a. B � °848 s State Gennrafols is It <br /> v') 4 Generator's Phone 7- <br /> co <br /> j5 Transporter i Company Name K r� 5 l;T 6i mtxr'G G C State Tramporte{s ID Q .DAG I, <br /> fes] (J •'T <br /> D Trarrspartar's Phone <br /> Q7 Transporter 2 Company Name 8 US EPA ID Number E State Transportefs ID <br /> U <br /> F T—sporter s Phone <br /> 9 Designated Facility Name and Site Address 10 US EPA ID z NumbG_-State Faallty's ID Number - <br /> 0 ERICKSON, INC. <br /> 50 rPt :1L°r ? li `2 rF r t� H Faaletys Phare <br /> 11 US DOT Description(including Proper Shopping Name Hazard Class and ID Number) 12 Containers 13 Total 14 Unit 1 r <br /> Z No 7 Quantity Wt/vol f Waste Number <br /> u�I L, j <br /> t SFOM <br /> G 6'3 s t f �` it1 0 rr EPA/Other g I <br /> o E <br /> 00 N b , <br /> R EPA/Ocher <br /> CD <br /> A s, s ` <br /> 00 T ` stab x� <br /> O F <br /> R EPA/other <br /> Z dLU <br /> Stale <br /> U <br /> EPA/Other <br /> J Additional DesrripMas for Materials Luted Above K Handling Codes for Wastes Listed Above t <br /> N a:EMPTY TAW(S) AND FIBERGLASS/STEEL PIPE a b <br /> rT � iso , C d <br /> Z <br /> Q 15 Special Handling Instruchons and Additional Information i^r o Tv <br />'? AVOID CONTACT w;-.r" S11, N/EvES SP—RVI---r &TQT10"4 <br /> y ,'/f -40UR EMERGEP,Ef l HGPIE 1;rrALL R _v-Zll fry/1-'' 30 LJ� c.l�-nn '"E D <br /> SDI. n`240 <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,n all respects on proper condition for transport by highway according to applicable federal state and international laws <br /> 1 If I am a iorge quantity generator I certify that I have a program on place to reduce the volume and toxicity of waste generated to the degree I have determmed to be <br /> economical practicable and that I have selected the practicable method of treatment storage or disposal current available to me which minimizes the <br /> economically p p gcurrently present and future <br /> threat to human health and the environment OR if I am a small quantity generator I 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 <br /> /Typed Na !!,, � Sig a / � , _iv '"� f«.t' '3 Month Day ear <br /> JI <br /> CIL <br /> r 17 Transporter 1 Acknowledgement of Receipt of Materials 1 <br /> R <br /> Pr Typed ante Signatu i Month Day Year <br /> LU s 14�(/ ��5 .e a . <br /> 0 18 Transporter 2 glario,ledgement of Receipt of Materials <br /> A Printed/Typed Name Signature Month flay Year <br /> E <br /> A <br /> 19 Discrepancy Indication Space <br /> a F <br /> A <br /> C <br /> 20 Facd Owner or O rotor Certification of recee t of hazardous materials covered by this manfest exce t as noted in Item 19 <br /> Y Printed/Typed Nome Signature Month Day Year <br /> 204441b08oF,+3-8R jr, DO NOT WRITE BELOW THIS LINE <br />`DTSC 8022A {12/91) Blue GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br /> EPA 8700.-22 To P 0 Box 4OO Sacramento CA 95812 0400 <br />