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h "tate of California—Environmental P-rotecfson Agency <br />rm Approved OMB No. 2050-0039 (Expires 9-30-99) <br />P se print or type. Form designed for use on elite (12•pitch riter. <br />O <br />N <br />n <br />N <br />09 <br />000 <br />O <br />�a <br />Da <br />r)Z <br />�- 0 <br />Q <br />Z <br />s � <br />3 <br />Q <br />Z <br />0 <br />a <br />Z <br />LU <br />Q <br />V <br />FA <br />See Instructions on back o �e b. Department of Toxic Substances Control <br />Sacramento, California <br />DO NO�GNRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br />EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br />Generator's US EPA ID No. <br />Manifest Document No. <br />2, Page 1 <br />Information in the shaded areas <br />UNIFORM HAZARDOUS <br />A <br />is not required by Federal low, <br />WASTE MANIFESTO'L <br />�0"*141LJ.nlol <br />S <br />011 101,3 <br />1 of I <br />3. Generator's No an ljng_A es� 3� <br />Fce(e r"4 w� <br />A. State Manifest Document Number ^ ® ® <br />L <br />t3o(� <br />- <br />15 E. &1(0vl+Iri <br />State Generator's ID <br />fB. <br />d. Generator's Phone– j' 1 1 Dd I I -7111 <br />5, Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID [lase rved ] <br />EC609Y Control Industries 91812 0 1 0 1 <br />D Transporter s Phone F .2 <br />ID, <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E State llrapsportee's ID [Reserved J <br />E Transporter s Pho?e t� , - <br />-pQGs�qgp tee�Fyci Naa g,lr d it Address 10. US EPA ID Number <br />LGItiUV jr <br />G State.factl t)F s ID <br />? <br />255 PARR BLVD.Phane' <br />RICHMOND CA 94801 D 0 019141616 9 <br />M,: <br />12. Containers <br />13. Total <br />14. Unit <br />1 1 . US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />' - <br />,f Waste., +- <br />r a-RCPuk HAZARDOUS <br />, WASTE OLID(EMP <br />TY STORAGE TANK)� <br />T <br />� <br />EPA/Other <br />P <br />j <br />� �O � <br />E <br />b <br />State ";, <br />z <br />E <br />R <br />EPA/Otker <br />A <br />C. <br />T <br />O <br />EPA/Other I = <br />R <br />"4'.y- <br />d. <br />State w 4't a <br />EPA/Other .�- �x 3r <br />J d' f Descc( r kf <br />1 6 tYlf"4 V�i11gp. Ya7 '"�'�,�i� <br />t"•'i`fy' Y P'iq"y <br />� }t5- <br />(� Eiandltn%Codes on�Vastes <br />@Psted Above , t <br />'.: `n ¢ M i.. <br />rc 11gfµe"!1.„ <br />�<' <br />d43:xAA <br />It'.:1�I4a <br />��`Y <br />19S•� <br />Cs'i?�:;. !,s 7 _`gD�,n':RgFT�y, WwIA <br />i <br />`Sy,y <br />YiW4rJ <br />rSi�"`�:{^'!F`Y3 <br />FW <br />Ror <br />M, <br />&9,5Htf?VW -hlle handling. Weights volumes are approximate. . <br />24 hour emergancy number: L-1 ocb-3 r cl --I 11 l SITE ADDRESS: 15'F. n Fan •f 1lo e- 4 d <br />24 hour emergency contact: 5ect✓, tLa ��o a ECI JIN <br />14 <br />S Z Tr --7 'Z `f <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, packed, <br />marked, and labeled, and are in all respects in proper condition for transport by highway according <br />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 economica11y <br />future human heolth <br />practicable and that I have selected the practicable method of treatment,. storage, or disposal currently available to me which minimizes the present and threat to <br />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 waste management method that Is <br />available to me and that I can afford. <br />Printed/Typed Name <br />Signal e <br />Month Day Year <br />91 G� <br />T <br />17. Trans orter 1 cknowle ement o ecei t of Materials <br />R <br />A <br />Printed/Typed Name <br />1griciury <br />Month Day Year <br />P <br />C� /I,/ /I' 1 / 0,-V <br />' _7 <br />z <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />-T <br />R <br />i <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />R <br />� <br />19. Discrepancy Indication Space <br />F <br />I <br />A <br />C <br />I <br />L <br />20. FociliOwner or O erator Certification of receipt of hazardous materials covered 6 this manifest except as noted in Item 19. <br />T <br />[PrLinted/Typed Name <br />Signature <br />Month Day Year <br />Y <br />f� <br />D <br />�S D <br />DO NO�GNRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br />EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br />