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ate of California—rivironmental Protection Agency <br />,rm Approved GMB No.-'050-0039(Expires 9-30-94) See Instructions on back of pagF Department of Toxic Substances Control <br /> ease print!r t.e, F;rm designed for use on elite(12-pitch)typewm Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST r p o 8 1 6 10 10 13 :D 8 1 6 of t <br /> 3. Generator's Name and Mailing Address SHELL OIL COMPANY A. State Manifest Document Number <br /> HAZARDOUS WASTE DEPT. 9 a <br /> P. Q. BOX 4848 B. State Generators ID <br /> 4. Generator's Phone (7,t )520-33 _ _y T qPS03 !Lt <br /> -GN <br /> 5. Transporter 1 Compa2.Name US A umber C. State Transporters ID <br /> r-1z- � _�-�.T Ir � kjL�5 �} c� 35 30 3q <br /> a D. Transp�rtees <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Trursporler's ID <br /> F. Transporter's Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> ER 1 CKSC'"., 1 NC. <br /> 2�.`_7 F,nF, BLVD. C A D 'v 0 9 /1 6 6 9 ` H. Facility's Phone _:.yI�-235-1393• .. <br /> r o6.?VSf <br /> 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name, Hazard Class,and ID Number) 12. Containers 13. Total No. Type Quantity Wt/Vol 1. Waste Number <br /> Ill C.I-i t<..L,1zL .Ul-iJI L ..ULI U, t <br /> State <br /> E e7 t[' P ./C..� <br /> N b• State <br /> E <br /> R EPA/Other <br /> A <br /> T C. State <br /> O <br /> R EPA/Other <br /> d. State <br /> EPA/Other <br /> J. Additional Descriptions for Materials Listed Above i K. Handling Codes for Wastes listed Above <br /> a:EMPTY TANK(S) AND FIBERSLA55lSTEEL RIP£ " b <br /> so <br /> C. d. <br /> 15. Special Handling Instructions and Additional Information <br /> IACILYIY: <br /> f;VDID CONTACT WITH SKIN/EYES SERVICE STAT?CIN' <br /> ...1 <br /> c f -NCY PHONE xU ,pip '80-0.) �"�.rr,_732t /i315) WATERLDO O„L!�,s <br /> llHOJR EMERGE <br /> • J <br /> A. <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 in all respects in 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 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 /> threat to human health and the environment:OR Ef I am a small aucntity a_enerator, I have "cde a 000d faith effort to minimize my waste generation and select the best <br /> waste nano ement method that is available to me and that I can afford. <br /> ted/Typed Name Si re {;�,[ i BE,�f��,i • �- <br /> `1 }� t_ ;�, Month Da Year <br /> -HELL Tt_ � c7 / <br /> T 17. Transporter 1 Ack wled ement of Receipt of Materials <br /> R <br /> Prin}[If Typed N me SigrWfure /Mont Day Year <br /> Pr — Rfc I "U L L/�f FJ7iN I (�/ � �/L/c�/ (/JI 7 C/. <br /> 0 16. Transporter 2 Ac owled ement of Receipt of Materials <br /> R <br /> T Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> 'CmTTc`I` '�('`}+rya` DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> iC 8022A (12/91) To: P.O. Box 400, Sacramento, CA 95812-0400 <br /> 8700-22 <br />