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-State of Colifomio--Environmental Protection Agency <br />orm App7oved OMB No 2050-0039 (Expires 9-30-96) See Insfrucfions in-kkack O je..6. Department of Toxic Substances CorMro. <br />Please print or type.. Forrn designed for use on elite (12 -pitch) r,,.ewriter. �`1 Sacrament._ r.lif.a,in <br />Lk <br />r111—. <br />C <br />Lj <br />u <br />Oct <br />C, <br />C <br />a <br />a <br />e <br />C, <br />c <br />C <br />Q <br />LL <br />t- <br />2 <br />LL <br />LL <br />V <br />C <br />LL <br />a; <br />a <br />Z <br />C <br />F <br />Q <br />Z <br />LL <br />2 <br />r <br />Q <br />U <br />J <br />J <br />a <br />V7 <br />Iz <br />Ct <br />U <br />Z <br />LU <br />0 <br />a! <br />w <br />LU <br />LL. <br />0 <br />LU <br />V) <br />Q <br />U <br />IJ <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/95) Yellow: GENERATOR RETAINS <br />EPA 8700-22 <br />UNIFORM HAZARDOUS 1_ Generators US EPA ID No. Manifest Document <br />No. 2. Page 1 Information in the shaded areas <br />WASTE MANIFEST <br />� is not required by Federal law. '. <br />I <br />of <br />3. Generators Name and Mailing Address <br />ROM <br />►Ea7 SCNOUt_ 115 1Gi <br />45TOc,wc-000 VN��I <br />t 9 4-4 L r E- .- U A DQ, '5 i �KcT0,U, C 6 <br />4. Generators Phone <br />x <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />1 <br />c O n rl? C ICIA 1 plplo19111414.1151117LZ <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />C <br />E` s <br />� <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />Erickson,Inc. <br />255 Parr Blvd. <br />yph����� <br />Ili <br />PichM d,CA. 946.01 P 1 4 b f 2 <br />y <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />Quantity <br />14 Unit <br />Wt/Vol <br />r day <br />r1Vr° <br />No. <br />Type <br />%U4—RC_TA fiazarr.k-4, Z Wcote Solid <br />srq i <br />EP <br />t,Izist.e f?apty St_.ora'7E T3l'k <br />T <br />r <br />E <br />. <br />r <br />N <br />b <br />Stare X1`1 r <br />, C <br />R <br />EPA/Other, <br />A <br />T <br />c <br />State:- <br />ta}e.O <br />0 <br />EPA/Other <br />R <br />d. <br />state .,.. <br />EPA/Other, <br />J. Additional Des c tions for Mafenals luted Above. ' <br />T•.wV� ?i "`d111= a lE -; .�.y <br />4*1 <br />K- Handling Codes for Wastes <br />a• <br />listed Above <br />b- <br />13fL�_f tir� .YS�V�' �'*4�• lC`6$;s��trT�.�:i},. �.t.t <br />_.. ,�. <br />��r�� 1JZ T r�V' vg i;sf}t fa *1?Cf C3C13 1 i <br />15. Special Handling Instructions and Additional Information <br />E� {+ r'1-'•�V fit:.kll-9,Aff'�-'es, of i(n-dti(47. Always 4,*Faa-D1Lar_}-fat-._ -,_b 'I"I �!,'ff'1CliI <br />T ► , (: , - - _. % 4 f f l' , t_ (b 1't:c C -F '. 1!N . C 1 l Os t-� R 5 ;1 C . Ii':'i)F' 3 � 4 / ` ; O <br />_ r _ __1.5 <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this 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 international and notional government regulations. <br />If 1 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, 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 />Printed/Typed Name s <br />Signature I Month Day Year <br />Le <br />��ll��l 1 1717 <br />T <br />R <br />17. transporter 1 Acknowledgement of Receipt of Materials <br />A <br />Printed/Typed Name <br />Signature ) <br />Montt! Day Year <br />S.•-. <br />' <br />f <br />c'J r <br />0 <br />18. Trans orter 2 Acknowledgement of Receipt of Materials <br />R <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />1 <br />L <br />1 <br />20. FacilityOwner or Operator Certification of receipt of hazardous materials covered b this manifest except as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/95) Yellow: GENERATOR RETAINS <br />EPA 8700-22 <br />