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Form Approved OMB No.2050-0039(Expires 9.313•= _ ioxtcsuaatancest.omrolums <br /> Phase print or type. (Form designed for usa on pitch typewriter). Sacramento,catifol <br /> UNIFORM HAZARDOU Generator's US EPA ID No. ManNet 2• Page t Information In the shaded areas <br /> WASTE MANIFEST A � Document <br /> a1 is not tequlred by Federal law, <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> Sam a J r� �,�J �.�.1 + \ -} ! ({--�n� �� L -S'��� �-, S 1 1 L. _ 8 - <br /> ���1 (� �yL .�� r/ B. State Generator's to <br /> 4. Generator's Phone(1 Jr) �j c f 4 j 3 7 J _ <br /> 5. Transporter 1 Company Name 8. US EPA )D Number C:.State Transportera)D<_: . ; _r <br /> N <br /> m <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E.State Transporters <br /> F.'Tranaportees Pttone <br /> m <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G Stale Facility's ID <br /> �� Erickson, Inc. <br /> a 255 Parr Blvd. H. Facility's Phone <br /> �a <br /> Richmond, Ca. 9480E <br /> riz <br /> LO <br /> Enainers 13. Total1. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Ouantity Unit Waste No. <br /> Type W1/Vol <br /> aa. State <br /> CO Uz 512 <br /> G haste Empty Storage Tank EPA/other <br /> Co NCalifornia Regulated Waste Only TIP 010151510 P None <br /> E b. t State <br /> NO R <br /> m A , <br /> m T EPA/Other <br /> N O <br /> R C- .State <br /> S <br /> m EPA/Other <br /> w d. State <br /> r- <br /> z <br /> LU <br /> U EPA/Other <br /> LU <br /> m I J. Additional Descriptions for Materials Listed Above K, Handling Codas for Wastes Listed Above <br /> Z <br /> O a. b. <br /> LIJ <br /> &s ty``Waste oil`tank, '42073y_icecI 1;111! bs��• �_ d• <br /> J <br /> a - <br /> Z <br /> O <br /> F. 15. Special Handling Instructions and Additional Information <br /> a <br /> Z <br /> uI <br /> r <br /> J <br /> J <br /> a 16. <br /> :J <br /> J GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> J and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and <br /> national government regulations. <br /> If I am a!urge ruam:ty generator,i certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined <br /> p to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> >- present and future threat to human health and the environment:OR,if I am a small quantity generator.I have made a good faith effort to minimize my waste <br /> U generation and select the treat waste management method that is available to me and that I can afford. <br /> Z <br /> LU Printed/Typed Name `-� SiQnatlxer ` f Month Day Year <br /> W /�� J/^� r(iii•� ..f r <br /> tUj T 17. Transporter 1 Acknowledgement of Receipt of Materials ! <br /> Z R <br /> a A Printed/Typed Name Signature Month Day Year <br /> LL S <br /> Uj <br /> f O 18. Transporter 2 Acknowledgement of Receipt of Materiala <br /> nl <br /> a T Printed I Typed Name Signature Month Day Year <br /> U <br /> ? R <br /> 19. Discrepancy Indication Space v1 <br /> r <br /> A <br /> C <br /> L I <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Mem f9. <br /> T <br /> y Printed/Typed Name Signature Month Day Year <br /> ENVIRON MF <br /> DHS 8022 A(1/86) Do Not Write Below This Line I �F <br /> EPA 0700-22 BIm GENERATOR SENDS THIS C CYTO DOHS WITHIN 30 DAY. <br /> (Rev.9-88)Previous editions are obsolete. To:.P.O.Box 400,Sacramento, CA 95812-04W <br />