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k <br />Ms <br />C <br />c <br />a <br />a <br />e <br />c <br />C <br />a <br />a <br />U <br />t - <br />LL <br />LL <br />1r <br />LL <br />S <br />H <br />Q <br />U <br />CL <br />V] <br />dX <br />F}C1 <br />V <br />Z <br />W <br />Uj <br />W <br />W <br />LA_ <br />O <br />W <br />to <br />4 <br />U <br />Stattr of Colifomio—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9.30.96) See Instructions on back aLegage 6. Department Department of Toxic Substances Cc <br />Please print or type. Form designed for use on elite (12pi writer. Sacramento, California <br />DTSC 8022A (1/95) <br />EPA 8700-22 <br />DO NOT WRITE BELOW THIS LINE. <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />To: P.O. Box 3000, Sacramento, CA 95812 <br />Generator's US EPA ID No. Manifest Document <br />UNIFORM HAZARDOUS <br />2. Page 1 <br />Information in 1ho shaded areas <br />WASTE MANIFEST'Lei <br />of <br />is not required by Federal law. <br />3. Generators Name� and Mailing Address <br />"" tote* ndest mart Nu <br />1 <br />A. Generator's Phone'Will <br />s <br />s <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />Cs*SttitecTn rtsporters0 �' <br />Dri _ r rets Plsone ��' i <br />t <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E 5 ircnsportela �IDs°f4 <br />t rets "PhtrnkF <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />Erickson,i11C• <br />vtu _ Fc tlrty's=a pt. xo <br />251; Parr Blvd. <br />H'Fac7Ut�s Phone �. <br />Ftic_t1lrtxnd,CA, 941:'01 1 t F Ej q C I <br />e <br />11. US DOT Description Including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />No. <br />13. Total 14. Unit ' <br />Type Quantify Wt/VOI a m' <br />a ;`1t�1-R_T1A .;.izarc3vu� GJaste Solid <br />G <br />E <br />44aste DiT_rty Storactf� Tank. <br />T P <br />c <br />P <br />N <br />b. <br />AR <br />; <br />E <br />R <br />A <br />$ <br />T <br />c. <br />Op <br />R <br />d. <br />I�i;Cci3r • f <br />r � <br />1 L <br />�a•�i <br />15. Special Handling Instructions and Additional Information <br />Keep awrriV i 2 _)til SOUrces, :Lf li:TnitlU,Z Pdways w._ar �1.:iZC1l:�tS w'.r�!� i_>Zli].I.a arouric.] <br />1.•' . G. j . _ 24L ` O:1 UaC !Vcti11� . 1 <br />16. GENERATOR'S GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described rbove •y 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 sterno anal and national 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 wast genet red 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 avc 'able t , 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 + 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 �/� s Signature <br />17. Trans Aer 1 Acknowledgement of Receipt of Mat rals <br />_ <br />I///) Month / Day Year <br />1 <br />R <br />p <br />ted/Typed Name Sig ature <br />Month Day Year <br />0 <br />18. Trans otter 2 AcknowledgeAwnt of Receipt of Materials <br />R <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />19. Discrepancy Indication Space <br />F <br />3. NO z4 <br />A . X60 783 - 2P�$ / <br />1 <br />I <br />Facil' Owner or rotor Certification of recei t of hazardous materials covered b this manifest exce t as noted in Item 19. <br />1 <br />T <br />T <br />F. <br />P 'sled Typod Name <br />Sig Month Day <br />C Q <br />/ 99Yea��r <br />�`�.� <br />DTSC 8022A (1/95) <br />EPA 8700-22 <br />DO NOT WRITE BELOW THIS LINE. <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />To: P.O. Box 3000, Sacramento, CA 95812 <br />