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State of Colifomio—•Ensfrcnroental Protection Agency <br /> Form Approvld OMS No.2050.0039(Expires 9-30.96) See Instructions on back of page 6. Department of Toxic Substances Control <br /> • Please printAor type. Form designed for use on e6le(12-pit wwrirer. Sacramento,California <br /> UNIFORM HAZARDOUS ne <br /> Gerators US EPA ID No. Manifest Documi„,,�/o. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFESTL p of <br /> i <br /> 3. Generator's Name and Mailing Address ryr0A USAr j 5 t o ti //1 4 ;A. *ft K�Ifest i ocurib .�l tnbe► <br /> 5. <br /> 92878, <br /> iP iox X'00y 3 f L , iA er+ <br /> CV A C � 7 j�J � � B: Sfa14-GOrMralOr�f(D _ r, <br /> toA..'seneralor's Phone ( ) i f C= �'l. C•. LR <br /> 5. Transporter 1 Company Name b. US EPA ID Number C. State Tran"000,0 <br /> � rampoAer's.phone• <br /> z'r cc k5a,-L _ C CIA ID010191,vig 14 D. idt3 S, -/ <br /> J 7. Transporter 2 Company Name 8. US EPA ID Number E Stahl TronspotW>E 0 <br /> Q ' <br /> U <br /> A IF. •I"taasporwit MCI" <br /> �. Z 9. Designated Facility Name and Site Address 10. US EPA ID Number Q.SIOW Fodwt`Itf <br /> 1 ERICKSON INC. <br /> V H: 255 PARR BLVD. Pk-- `- <br /> U RICHMOND, CA 94801 CAD 0 0 9 4 6 b 3 9 2 41$) 1393 <br /> Container 13. Total 14. Unit <br /> Z No <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol 1.Wats Nsettbet <br /> 2 Skoe <br /> n0. <br /> N��OppN-yRC�R�Ap�Z GE T WASTE SOLIDI WASTE '512 <br /> G JRG M % © T P U P ANK fPA/o <br /> C'' E <br /> 00 N b. Skft <br /> E <br /> C4 R EPAJ011ks <br /> A <br /> Cg T c 5taEe <br /> 0 <br /> O <br /> R EPA/Other <br /> W <br /> Z d <br /> Z <br /> W <br /> U . <br /> EPA/Ehhea <br /> W <br /> Z <br /> Q ¢opt.fbr•f4lf+ietfoA�t fC. Codee for�Ke�4s llsted Abew <br /> _ , <, <br /> (na. <br /> tn <br /> W <br /> d. <br /> uastI7�001 AL. AM TWO �adk <br /> J <br /> 0 15. Special Handling Instructions and Additional Information <br /> ~ KEEP AWAY FROM SOURCES OF IGNITION. ALWAYS WEAR 24 HR. EMERGENCY CONTACT <br /> Z HARD HATS WHEN WORKING AROUND UGSTs. NAME:L.hr ,Uj F �:•:�frF�ro <br /> 24 HR. EMERGrENCY PHDWE <br /> X6 6 73 PHONE: <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 /> Upacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <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 /> J <br /> a 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 /> V) 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 /> rY waste managernent method that is available to me and that 1 can afford. <br /> � <br /> 0 Printed/Typed Name /!'. j� l-7--- Signature Month Day Year <br /> � Je G <br /> .� ,,2- y la III q15 <br /> Z 1 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> (LU A Pr' d/Typed Na Sig re �I Month Day Year <br /> W S "i /� �. <br /> W0 18. Transporter 2 Acknowledgementof Receipt of Materials <br /> W T Printed/Typed Name Signature Month Day Year <br /> 0 E <br /> R <br /> tWj, 19. Discrepancy Indication Space <br /> Q F <br /> U A <br /> Z C <br /> I <br /> I Z0. FacilityOwner or rotor Certification of receipt of hazardous materials covered b this manifest except as noted in Mem 19. <br /> T Printed/Typed Name Signature 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 />