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MMR-19-2010 10:37AM FROM-EVERGREEN OIL 510-791-0126 T-070 P.009/017 F-327 <br /> —on Its Mtn.mwnw �..Yrw.y uv nYx..,.+��.�... �. .-.•. •.•�••.. w�a FormA roved.OMB No.2050.0039 <br /> Fbso Print or type.(Form designed 14 a on slue 12-p mer.) <br /> UNIFORM HAZARDOUS 1 �na alor!D�ryu r 7 Pape 1 d 3.Emergency,Response PhonsJ 4.Manliest TracFlCg Number <br /> WASTE MANIFEST L U ' ( l .v ! 1�•u4_gm 002586952 JJ K <br /> 5,Generators Name arta Mating AddressGene2lo$Slla AduoeSSllditNront an marlin address) _ <br /> ox <br /> GlnemNfe pions. / ;'-Y/ <br /> 6.Transpaner i company Name .S.EpA Ip Num6or <br /> Evergreen Environmental Servioes CADSM13262 <br /> T.Transpoher 2 Company Naha U.S.EPA 10 Number <br /> 8.Designated Faddy Name and SdaAddrurs U.S.EPA Ip Numbor <br /> Evergreen oil, Inc. <br /> 6880 Smith Ave. <br /> Newark, CA 946W <br /> Fadbys Phone: 910-795.4400 CA 7418 <br /> ga I So.U.S.DDT Dowry'mien Including Now Shtpphl8 Name,Hazard CAMS,10 Number, 10.Conranen 11.Total 12.Unit 13.WasurCcoes <br /> HM and Packing Gm P(6 alp)) No, Type Guanlhy WILWn <br /> W <br /> all 2. <br /> W <br /> 4J , <br /> 3. <br /> 4. <br /> 14.6 el endlln vursicrosanaA0W Ilnlo•meion <br /> 15. GENEM�_T/TOR''S/01IIII R'S CERTIFICATION: I herebydedere mat the contents of inns comignment ala filly end Vxwra:ey 0651 about Dy rya proper wrppig name,and am daeslged,packaged, <br /> marked and mnelempacarekd,and are M all respects In pmpsr cor l6On(Or hansom according to applImble Inlema6onel and national governmental reguledons.If export shlamenl we I em me Pdmap <br /> Exporter,I car*that the emlents of this WrHgnment mnfeml he the terms of Na attached EPA Acknowledgment of Consent. <br /> I car"mai thetvese mInInk=on statement Id eml6ed In 40 CFR 262.27(a)101 am a Irapa glleney geramety)or(h)(6 m a amen yuan eremr)Is due. <br /> GenNaWrdOffa ore PnnreoFTypad Sommers mwt Day Year <br /> G <br /> F <br /> 16.Intermadend S Ipme <br /> Z ❑ Ll to U.S.u.3. Expat from U.S. Po ambit Ih <br /> Transporter Mignawre(far exports any): Da a kedng U 5.: <br /> 17,1Tansportor edgment of Receipt of mcallals <br /> TrrnsPomar It SI9aaMa M.onl Day Y <br /> O0. CJ <br /> rpleponer 2 Fdnl rypccN me nature month Day Year <br /> 19.Di9cmPancy <br /> ire.Dlscepancy Imitation Spate ❑ ashy ❑Type ❑Res'due ❑Parti Reisman ❑FuA Reledon <br /> A1amJeel Rolonumm Number. <br /> 19e.Allenjam Fatally(o Generator) U.S.EPA ID Number <br /> 1 <br /> U <br /> w FaoplHa Phone: <br /> 181 Signahue of Allaman Farlllty(or aneramr) Mown Day Year <br /> b <br /> R <br /> h19,Hazardous Waste Report Manepemom Melhw Codes Pe,eWea for hazardous waste treeenent 6smsal,and razyding systems) <br /> 0 1. 2. 3. 4. <br /> N 114 I <br /> ZD.Oedpnalea FadY'tyAmorar OpamlOn CallCcaeon of mceipt of ha2aNdus moments covet90 Dg Pie mart8esl extent as ntletl in Item Ula <br /> PdIntearTypern Name 3l®IaNrs Moo Dry Year <br /> EPA Form 6700.22(Rev.3-05) Przvicus ad6lorls aro obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />