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Fonm dFT1o.40.�C1.0tU9(E s-6L7094J• 'i�'t-f. - See 111fh1/C�OIf CI[of pOgi � `! Deparw"nt -$sbaa�dsol <br /> ► - form dfliprrd <br /> for oe eb►(Ilyfkdt) , ; t - _ .? `.L - :.�" w,- ' 1 t _ 'Soaraanrb,CoYionmta <br /> L" <br /> s {s' 1• GAIralicies US EPA ID No. h Manifest Doin—No. r, pope 1 <br /> HAZARDOUS kdias ormatin Owtdwded a�at <br /> �JNIFORM aR. <br /> WASTE MANIFEST C A L '0 0 0 1 1111 9.10161 <br /> 0 0 0 0 2 On��Oaa <br /> 3. Generator's Name and Mailing Address Zuckerman-Mandeville, Inc. <br /> P.O. Box 487 <br /> 1 Stockton, CA 95201 <br /> 4. GenerotodsPhone ( ) (209) 464-8355 <br /> 5. Transporter 1 Company Name 6. US EPA ID Number <br /> u0 Falcon Energy A®sociatea CAD 9 8 2 5 2 6 8 5 7 <br /> n 7. Transporter 2 Company Name 8. US EPA ID Number <br /> 1 <br /> gDesi EacilitKNa and Site Addre 10. US EPA ID Number <br /> tatgev�ae bnv3.ronmenta.L <br /> 12618 Main Street <br /> a Los Angeles, CA 90068 CAD 000088252 <br /> N11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> No. Type Oumfity Wt/Vol <br /> RQ, Waste compressed gases, flammable, <br /> > E n.o.s. , 2.1, UN1954 (used aerosol cane) 0 0 1 D t. P <br /> N <br /> c, <br /> B RCP <br /> L&Non RC & hazardous waste, liquid � <br /> ry R (oil and Water) 0 0 ' D - G <br /> d <br /> "+ A h (- <br /> T Waste Sulfur, 9, NA1350, PG III <br /> O <br /> R 01 01 D <br /> W i I ; P <br /> 7 d. <br /> z <br /> 0 <br /> a <br /> Z 15. Special Hand 2 <br /> 16sg Insnadioro and Additional Information 4 Flour emergency response number' 1 00 99-HELP <br /> A. P-15019 <br /> 11b. P-15111 <br /> z 11c. P- I `1 <br /> 16, GENERATOR'S CERTIFICATION: I heret y declare that the contenri of the consignment are fully and occurately described above by proper shipping none and are classified, <br /> pocked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> V <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, if I am a small quantity ener �,,I,,hq madds�a,.ppood faith effort tgqp9�+mint�ze m�wa�sstte gen�ratign and select the best <br /> waste management method that is available to me and that I can afford. <br /> 'i C) LUCICerman—l`RSnC ev le, 1nC. <br /> 0 Printed/Typed Name Signature / �— Month Day Year <br /> T 17. Transporter 1 Acknowled entero of Receipt of Materials <br /> R <br /> A Printed/Typed Name Signature Month Day Year <br /> 5 0 18. Transporter 2 Acknowledgement of Recei t of Materials <br /> R Printed/Typed Nome Signature Month Day Year <br /> E <br /> R <br /> W 19. Discrepancy Indication Space <br /> V) <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facil'� Owner or Operator Cerfification of receipt of hazardous materials covercd by this manifest except as noted in Item 19. <br /> T Printed/Typed Name ;� Signature / / Month— Dayr <br /> O NOT WRITE BELOW THIS UNE. r <br /> iC 8022A (7/92) / <br /> c,A 8700-22 Green: HAULER RETAINS <br /> _ �JY- <br />