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U206 4427159 TOSCO SEATTLE 2003 <br /> Sicokpi Cnhfarn,a-$nvironmenlal Protection Agency <br /> Form'Approvvd OMB No 2054-0039(Expires 9 30-96) See Instructions on back of page �'j Department of Toxic Substances Conn <br /> Please prmi or type Form designed For use an elle(12p+lch)typewriter I �`G�%,[�.r Socransemo Caldomto <br /> T Generators US EPA ID No Manifest Document No 2 Page I Information In ilia shaded areas <br /> UNIFORM HAZARDOUS %not required by Federal low <br /> WASTE MANIFEST _ oI� <br /> 3 733,op.,N..e rid Mailufg Address 7 5-71 r' �1 .t� r` A' 5tfrto Manifest Oocvmant Number <br /> [� �`Cj. r of�., •���f'� i r BY Stoic 13anerator s ID <br /> N <br /> +� Generators Phone 1 7 L <br /> O5 Transporter 1 Company Name 6 US EPA ID Number C t5tate Transporter'[D <br /> ^ � ' ! ✓ !L/ (� 4"Traruparter' P i �T 3 5 y t�M s �a <br /> 7 Trans <br /> Q poser 2 Company Name � B+ US EPA ID Number <br /> Z 9 Designated Faulrty Nome and Site Address 10 QTS EPA ID Number G tcftffac11mr=1Dt <br /> 0 L r r> r err 'E I' , H'Fattllly sr Phone ,ry �!Wit..'"r���.+ ,ry.� •" 'fs: <br /> �� C ? <br /> ,r k <br /> J a Q ftl+lrlTIYTl1e 1 I N I �'t; _ tt + C) +J 'i i e, iy z i � ,,� �'„ <br />�L%\ ("f 12 Containers 13 Total 14Vilit <br /> N <br /> z 11 US DOT Description(including Proper Shipping Nome Hazard Class and ID Number) No T Oua hty Wt/Val � � sh5m�er '-fa <br /> C37 <br /> H:' - IL 1< i -t g31 S�+ <br /> E <br /> mN b si <br /> cc <br /> CN R I r r Y l?3 <br /> A <br /> T c 5 . <br /> O EPA' sF rte, <br /> e <br /> oe fRUj <br /> Z I � + r <br /> d S 1� <br /> w .. ,1, `." ,Cr <br /> Z !„Additional Hans for Mtstenals flsled Abvvo .- �, ?f p} .^ ' K Acindi,na Codes{o�Wasr£s Gsie3'Ab ire-r 'a ;' <br /> OQ 'j h� � Stoag �' LC 5? a b <br /> N �r �r_ ; <br /> Tank(sihave been h� w�.th I'S <br /> -� t <br /> O 15 Special Handling InstriudiOnL and Addnwnal Information <br /> ~ f, AWci4 fY+if11 "'iLkl (7-S t 1Z11t2.r'IIi 1I� sV= '-'tl Ile^d]� icy �s �s, y+ ar_ 1'1✓«1 <br /> Z ill G T _: 'u 1iL + -int :IrITT!`- --4111 Fl F'tt�lgr-'max`�Icr=-> �� r (' <br /> LU <br /> r <br /> 16 GENERATOR'S CERTIFICATION I hereby declare than the contents of thin consignment 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 mternahonal and notional govemmonl regulations <br /> V <br /> If I am a large quantity generator I certify that I have a program in place to reduce the volume and ioxiary of waste generated to the degree l have determined to be <br /> decononv�ally practicable and that I have selected the practicable method of treatment storage or disposal currently available to me which minimises the present and futwe <br /> I <br /> Ln threat to human health and the environment OR if I am a small quantity generator 1 have made a good forth effort to minimize my waste general,on and select the best <br /> 0.w waste mane ement method that is available to me and that I con afford <br /> O Pr am Srrs r Montes Day Yea <br /> tj <br /> Z 1 17 Transporter 1 Ac nowled emerit of Receipt of LAgeacils <br /> ' -- <br /> ,p Si t l _ Day -Yeat <br /> w 5r ` �1 f <br /> P <br /> ILLI 0 18 Trans iter 2 Acknowledgement of Receipt of Materials <br /> RPrinted/Type Nome S+gnan+re r/ µonNs Day Yea <br /> R <br /> rW 19 Discrepancy Indlcatton Space <br /> Q F /:�Z 3 "j-, 514TWro /N SCCnw\J J <br /> A <br /> Z I <br /> I <br /> L <br /> I 20 F lay Owner or Operator Certification of receipt of hazardous matenglt covered by this mondani except as noted in hem 19 <br /> T Printed 7ypad Nome S.gtsaUrre Morifh Day Yco <br /> 1 : <br /> DO NOT WRITE BELOW THIS LINE <br /> I _ f4ow TSDF SLNDa THIS COPY TO GENEFTOF vvkrhIN JO DA"b <br /> (Gener.r7 +e ss who tubmf,aoov <br /> . ,au ] <br /> I ,n par -r-I to r <br /> DTSC 8022A (1/95) '� `� p,r ducs completed Lopy of this .0 j + <br /> EPA 8704-22 T _ <br />