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U <br />u <br />' <br />C <br />a <br />u <br />U <br />a <br />2 <br />C <br />h <br />2 <br />LL <br />1- <br />Q <br />U <br />CL <br />Vi <br />W <br />0 <br />U <br />Z <br />W <br />W <br />W <br />Li <br />O <br />W <br />t� <br />CEJ <br />/ oa <br />Forts Approved OMB No. 2050-0039 (Expires 9-30-96) / `i See Instruction; on back f 9e 6. q/�q Department of Toxic Substances Co <br />Please print or type. Form designed for use on elite (11 -pi writer. / <br />Sacramento, California <br />DO NOT WRITE BELOW THIS UNE. <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />DTSC 8022A (1/95) To: P.O. Box :5000, Sacramento, CA 95812 <br />EPA 8700-22 <br />UNIFORM HAZARDOUS neral°r's US EPA ID No. <br />M mifest Docume 2. Page 1 Information in the shaded areas <br />is not required by Federal law. <br />WASTE MANIFEST ° C <br />`' of <br />'t°is Name and Mailing Address ,, `` / <br />3. Ge,'�'it(C AC <br />6.)c -,e J 7^ <br />- mfest <br />, <br />Generator's Phone yam® <br />fafel orator' D <br />p4. <br />5 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />c£4 ransporl t if <br />D roti rter's Phone ' <br />7. Transporter 2 Company Name B. EPA ID Nu r <br />i <br />,E "I'Sti licinsportels D <br />ccissporters Phan <br />C <br />"St6te:F«ility's ID. " <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />Erickson r Znc . <br />10I,nJOQf <br />255 Pa's r Blvd. <br />ticilily's ohone, <br />P.ict'11xmr3 CA. 94ti;1 C Al0 0 9 4 <br />6 6 1` <br />11. US DOT Description (in <br />(including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Cont <br />ainers <br />13. Total <br />Quantity <br />14. Unit <br />Wt/Vo)�, li I I I <br />No. <br />Type <br />a* NON-Ril HCtzi-u does Wa: t.e Solite <br />G <br />i E <br />Waste Empty Storat7c_ T,i <br />Tip <br />( <br />P <br />s N <br />Is. <br />t E <br />t R <br />A <br />5 T <br />C. <br />O <br />R <br />i <br />i <br />i <br />d <br />i <br />'`�' Itng. Codei <br />r.y <br />�T <br />15. Special Handling Instructions and Additional Information <br />FCet_b away from S0i11.i of iC(riition. wear halAhzits wh :'i wOrkinc7 c.]:OUnd <br />-aWays <br />' - 2 �4 t Nam <br />U.G.•.,.T, _ Hr, Contact t_ tl� � .�,_ <br />& 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 />packed, 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, 1 certify that I have a program in place to reduce the <br />volume and toxicity of waste g,:nerated 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 1 am a small quantity generator, I have <br />made a good faith effort to minimize my waste generation and select the best <br />waste mono ement method that is available to me and that I can afford. <br />Printed/Typed Name <br />Signature /! <br />r Mh . Da Year <br />r <br />T <br />R <br />17. Transporil 1 Acknowledgement of Receipt of Materials <br />R <br />Printed d me <br />Sig tun <br />oath Day Year <br />C <br />S <br />e ��� <br />0 <br />18. rani rter 2 Acknowled ,mann of Recei t of Materiols <br />T <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />A <br />_ <br />19. Discrepancy� Indication Space <br />A <br />A• 5to 23S- IN 3, <br />.1 <br />L <br />1 <br />20. FacilityOwner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />Prirsted/Type � � e <br />Sign I J Month Day Year <br />DO NOT WRITE BELOW THIS UNE. <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />DTSC 8022A (1/95) To: P.O. Box :5000, Sacramento, CA 95812 <br />EPA 8700-22 <br />