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' State of Caklorn+o--Enhronmeretal Protection Agency <br /> Form Approved OMB No 2050-0039(Expires 93D-94) See Instructtons an back of page b Depoirtipgret of Toxic Substances Cont <br /> Please print or type Form designed for use an ehfe(12-porch)typewnser Sacramento Calif*— <br /> A le 1 Generators US EPA ID No Manifest Document No 2 Page 1 Informalew in the shaded areas <br /> UNIFORM HAZARDOUS <br /> is not"fired by Federal law <br /> WASTE MANIFESTGenr- q g t �f S 1 15 i 1 of <br /> 3 erator's Name and Moiling Address u SHELL O i L COMPANYIn <br /> HAZARDOUS WASTE DEPT. <br /> N 1 .0. BOX 4846 <br /> 4 Generator's Phone <br /> 00 (-714)520--3,312 ONAHE I MCA ?28K, <br /> m <br /> d 5 Tr rter 1ny Name I Nu C_ State TraasrorlerstAlY•!!n <br />' J L e � _ D Trtmsporters ; <br /> Q7 Transporter 2 Company Name 8 US EPA ID Number E State Transporters IA -"?'Su <br /> V � , MF <br /> F Transportees Phone r <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number G e State Faaflly s ID t ,ai _ <br /> �t <br /> ` v R i CKSON, <br /> t <br /> V uJ =55 <br /> 55 r nRR LL_sa-' H Faaley's Phone r'5IV'2 <br /> �5- <br /> 3 <br /> V `11 <br /> US DOT Description(encludmg Proper Shipping Nome Hazard Class and ID Number) 12 Containers 13 Total 14 Unit <br />©Z No I Type Quaste Quantity Wt/Val f Waft Ntember <br /> � a; + , i r •�ilLti ,f.)c.c_,� ,ire.` _,..L . , � $tate <br /> 3 . 0 <br /> Cs Iq7 I1 P , Iv C EPA/O00%, a <br /> E �a <br /> co N b Stara <br /> E <br /> N R EPA( <br /> v A r <br /> o T c I State. <br /> 0 <br /> IR EPA/t <br /> w <br /> Z d State r A, <br /> w <br /> V <br /> EPA/011ier <br /> J Additional Desysptsons for Matenals listed Above 1C Handhag Codes for Wastes Listed Abdve <br /> a <br /> ac-EMPTY TANK(S) AND FIBERGLASSISTEEL PIP a b <br /> L <br /> LU <br /> a <br /> L_:LL 15 c d <br /> Z <br /> Q 15 Special Handling Instructions and Additional Information .r i <br />' Ct ^i h r T r 1rt, i 7C TI 7 s <br /> �urrl��r }l'.ul�Ie��Lrtri--wlIJ ((J� ..:{r > � -f7��e �n `�.i�y,J_L.�.+. rr77r��_� <br /> w <br /> i:4 HOUR Eiy'EFLE%Cj r t"1 L�i�t !<rLl tr(F.7�1Y C?r:.i iUi �f Lei"`���Ys iL tSO •r'1L700 ?0'r TI <br /> = s_1_.....I. ori. '2 0 <br /> J <br /> 16 GENERATOR 5 CERTIFICATION I hereby declare thin the contents of the consignmerit are fully and accurately described above by proper shipping name and are classified <br /> Q packed marked and labeled and are in all respects in proper condition for transport by highway according to applicable federal state and international laws <br /> U <br /> .S If 1 am a large quantity generator I certify that k hove a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be <br /> 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 /> I N threat to human health and the environment OR if I am a small quantity generator I have made a good forth 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 /> /T ped Name k Si re LT.' ���I,L i „i^ Doth D CYear <br /> U <br /> Z T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> W R <br /> w s �J d yNJ /fC L/ •FN /� Sig a C�rith � Year <br /> r <br /> i <br /> LU Q 18 Trans i <br /> rte,2 Ack Dated bent of Recei t of Materials <br /> T Printed/Typed Name Signature Month Day Year <br /> LL E <br /> Q <br /> w 19 Discrepancy Indication Space <br /> V) <br /> Q F <br /> U A <br /> Z I <br /> I <br /> L <br /> I 20 Facile Owner ar O rotor Certification of recei f of hazardous materials covered bX this manifest except as noted in Item 19 <br /> T Pnrrted/Typed Nome Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE <br /> I DTSC 8022A (12/91) 81To P O Box 400 e GENERATOR SENDS <br /> Sacrra Sacramento CCA opy TO 9 812 WITHIN 30 DAYS <br /> 0400 <br /> EPA 8700-22 <br />