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Please prima .(Form.designed fpr use on el'de(12-pit .pec) � Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDDUS 1.Genealu ID Number 2.Page 1 at 3.Emergency Response P 4.Manifest Tacking NNuumber('� C <br /> WASTE MANIFEST p 3 a 1 a a- rL ��. U 1 O 6 0 0 0 5 G B F <br /> 5.Generators Name and Muting Pddress Genaalors Site Address(it different than mailing address) <br /> CENTRAL SPRINGS INC <br /> 1616 BOEING WAY <br /> STOCKTON,CA 95206 <br /> Generators Ph <br /> S.Tansponer 1 C-P y arta- U.S.FPA ID Number <br /> FREMOUW EWIRONMENEALS VI INC7 <br /> 7.Transporter 2 Company Name U.S.EPA D Number <br /> S.Designated!Facility Name and Site Address U.S.EPA ID Number <br /> EVERGREEN OIL INC DA1jIS cA0982446874 <br /> 44561 ROAD 3" <br /> DAVIS,CA 95616 <br /> Facifity'a Phone:510-795440 <br /> gra Sb.U.S.DOT Desorption Imposing Proper Shipping Name,Hazard Class,10 Number, 10.Containers 11.Tote) 12,Unit <br /> Quantity Vft1Vd. 13.Waste Codes <br /> HM and Packing Group If any)) No. Type <br /> c 1. Non-RCRA Hazardous Waste Liquid(Olay Water) ) -'BHr•- r G 723 <br /> �a <br /> f9 <br /> 3. <br /> 4. <br /> 14.Spe®I Handling Instructions and Additional Inlamation <br /> Handlers to be 40hr trained and use ppe. <br /> ERG#171 <br /> 15, GENERATOR'SlOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately desuibed above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeadtplecarded,and are in all respects in proper condition fu transport according to applirabie international and national governmental regulations.It export slopmenl and I am the Primary <br /> Exporter,I cent y that the contents of this consignment conform to the toms of the attached EPAAckno viedgmenl of ConsenL <br /> I certify that 0te waste minimization statement identified In 40 CFR 28227(a)(rf I am a large quantity generator)or(b)(If I am a small quantity generator)is hue. <br /> Gen afrnadRyped Name Signalua Month Day oc� /0 <br /> NAN&18.International Shipments �f"au `-fz- <br /> F ❑Import to U.S. El export from U.S. Por of entrylexit <br /> Transporter signature(fa exports only): Date leaving U.S.: <br /> W 17.TransporterAtlmoWedgrnent of Rao*of Materials <br /> E" T 1 PintadMma a S nate Month Day Year <br /> GTransporter 2 Printed/Typed Name Signature Month Day Year <br /> (Y <br /> I <br /> is.Discrepancy18a Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Fug Rejection <br /> Manifest Reference Number. <br /> 181b.Allemaa Fadity(or Generator) U.S.FPA ID Number <br /> J <br /> V <br /> LL FacABYs Prions: <br /> w ii Signature of Alamate Facility for Generator) Mona Day Year <br /> Q <br /> 2 <br /> H 19.Hazardous Waste ReportMeragemCodas(i <br /> entMethod e.,codes for hazardous waste treatment,disposal,and retyping systems) <br /> 1 1' 11yI 2. 3. 4. <br /> 20.Designated Facility Omar or Operator.CeaAcedon of receipt of hazardous miler es covered by 0a maniasl except as noted inIt <br /> tediTyped Name Signature - Month ay Year <br /> Q w NGF ON YE NSF -d. <br /> 5;AForm 8700-22(Rev.3-05) Previous editions are obsolete. <br /> DESIGNAT ED FACILITY TO`DESTWATION STATE(IF REQUIRE[ <br />