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JUL-24-2006 06:12 FR00-EVERGREEN OIL 510-791-0126 T-250 P 002/003 F-901 <br />ease prim or type. (Form dodigned for use on mile 02•gilf- <br />UNIFORMH RDOUS 1.G orator 1D Farm / n 2P 1' )Einer Farm Approved. OMI <br />WASTE MA (FEST V Benny Raspanse PAme l Man et Tnekgy N� .b., <br />3Y ,�24° 0025-83-9 53 <br />S. GerWralolaN no And Mating Ad re9E <br />'E Generators Shc Am ire as rf di an,nulrga meet) <br />�z Sf �y D <br />6. Trmdnspspotlmp <br />I Warty Na <br />E <br />E reenEnvironmentalServices us.EP�DNtan`�aet <br />7. Tmnyponel2C panv Name _. CAIW2413262 <br />i <br />- ---e ...v . — <br />,r nen.. euu O"e I1Opmy. <br />Evergreen 2)11, Inc- <br />U.S. EPA IS Ndmdm <br />510- <br />95440 6220 Smith Ave. <br />Newark, Ca. 94560 <br />'36111'a Pndne: <br />'-A 119.0022741S <br />Se 95, U.S. Of <br />HM aMPAWn <br />T DeSdnplion jui,,leng Proper Shipping Name, heard Curtis, tD hi,mel. <br />amup (11 any)) <br />10. C"wir , <br />Ir0 TfpE <br />It. Total <br />Quantity <br />12. Unit <br />N 17. Waste Caaya <br />Wear I ra:eativeEquipment ERG# (� T <br />Invoid # Saks greet# <br />GENERATOR'S FFEP.OR'S CERTIFICATION: I hereby dedpte Mal the COnlellm of lnin ennslgnmenl are Welland accurately afaUod am" by Ilio propel rppinq name•aw are dassiged, acs <br />mverd and la Ipincaideft, and ate In all Impel 5 in Prow mnddw fo.' pan p pfd• <br />Espanol, l Cindy hal he mnlem5 o1 Ilii; mnsl n epad accord PA to ma.lid lu eni of c international nallenal go.ernmdnlal regNallp c. If Etpon phipmem one l am the Plurally <br />g mans wntdml Id IM• Inline of me aIUUWd EPAAdugwledgrtpnl o! Cannent. <br />IlOrldylhauney Sle nlilVmizalidl slalCmenl idenllhad <br />nuMJORomrdP m40 CFR 262.2]la)(IlemaldrgC guanily genua IV) a(orvl <br />)(it l am a small gvanety geneor) is line. <br />'ledyrypep Name <br />1— //� SignaWre <br />'�i/ ^ \ Mona' Day t <br />emapo Shp, I5 O 1 ,� I .7 I6 <br />Impm to u.5. ❑ Eapdn kms U.S. on of kvi I b-� <br />Pdner signature 3r Won, dmyJ: brat C <br />Inspdrer Achnowldgmenl 01 RBCaipl of MaledmE Dale W Jviny U.S.. <br />LJ Oupnmy LJ Tym 0 Re," <br />_. Mnnilml Rnle <br />FSWiIy s Plane. <br />talc Slgll9are of Alloma Faebtp forC,.n ,Wr) <br />19, Hazardous WastePon on Manapemenl Idmhod Coags fix,main <br />1. a� � 2. <br />20. Designated Fechily 0 nor lor Operelar. Cenillmpon of mceipl of h; <br />ifinedrFVPm Nnme <br />4 1,. -a A,, i- ]r1 <br />maledels <br />I_j Paulo R.WAO ❑FuaRejmim <br />no mamiusl oaapt as need In Ile, tea <br />_.. Signature - - <br />MOO Day Yoar <br />1- oy 1o3 01 <br />OESIGNATEO FACILITY TO OESTII• ATION STATE (IF REQUIRED) <br />