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11AR-19-2010 10:37AM FROM-EVERGREEN OIL 510-791-0126 7-070 P.011/017 F-327 <br /> ,..0 rtypr'dWr, de n.e oopyw_ite 12 _...... <br /> . <br /> Ple se piml or type.(Form tle3igned far use on dile(t2 yiI_ , Mier.) ' <br /> UNIFORM HAZARDOUS 1.Genomlor 1 2.Page t d 9.E ix ILII CY Responu Phone 4.Manlroal Traeklnq Nwnber <br /> WASTE MANIFEST �� Y 1 1-soa,a2A 002586 9 7 7 JJ K <br /> 5.Generetpr s Namc rad Marling Aadra e Gcnenrers 6x1��s(ilGlla mine rnalli <br /> G neraloTs Prtone: s <br /> porter t Campspy Narge US. AI0 Number <br /> 6.T <br /> vergreen tnYlrUnmental Services CAD982A7326L <br /> 7.Tlensparlel 2 Company Name <br /> U.S.EPA 10 NOMI <br /> B Desgnated:acttilI Name aM Sim AdoressEYergrven-Qa,,I no- U.S.EPA ID Ndmbea <br /> s$$Q'.rifTltET'AY.@. ' <br /> Newark;CA 8455 <br /> Face ry's Prone- <br /> 510 795,1400 CA7A18 <br /> 9, 9b,U.S.POT 0a.tnplim QnduOing Propel S,.I Name,HaMO CIa2e,10 Wear, 10.Conte'an!rs 11,Tout 12.Ind 13.Wrist codes <br /> NM and F3NirV GIMP(1 UI No. Type 0uan6ry wulval. <br /> t <br /> ? 2 <br /> W <br /> 3. <br /> a <br /> T4-5 pKIM Handling InatDoCrons and Additional Informstim <br /> 15. GENFRATOR-31OFFEROR'S CERTIFICATION: I hereny dcdapa.11tpl the W tints or this consgnmere are 51q and accurately described abma of IPe proper shipping axis,and are dassif al.pardragoo. <br /> marked and xnelcdrplecerdcd,and ere in ae nupects in proper cwdilimn for tixa>rgod sworontj to applirable xtemeaonaa and national Ilmorem"!reguhniona.If export aNpmenl Vo I am per Primary <br /> Exponec I cardly met rhe cement,of the consignment conform to file IamK of the afreI EPAAckeowledgmml of Gena <br /> I oortly tree Me waste mimmf:alion statement denphed in 40 CFR 262.27(a)Ir I am a Lugg guanary generator)or lo)(if I em a WN quantity generaxf}'s vac. <br /> Genermpew0fiaors Primed/Type meS'gneture LIM" par lter- <br /> III >� dU a2 <br /> —s 16.Inlemedanal SNpmems <br /> ❑Import to U.S. Export from U.S. pen of enlrylexh: <br /> x Tranmorvd signature)lar exports only}: Dale IOaylftg U.S.: <br /> Cal 17.Transporter AW dgmerpof ReeI of elene4 <br /> _ _ _ _ 0% ...Year.. <br /> o _ <br /> CTra 2 PAnxdrfypell Name S uta Doth DaY you <br /> I <br /> 1a.lowrepay <br /> tea.Discrepancy lnolestm,Space Ovandry ❑Type �Repm ❑Pani Rejection El FOR Raiscion <br /> }- NemfoSf Reference NuMba <br /> c n <br /> 1m.Anamalc Faaery(m Generator) U.5 EPA 10 Numour <br /> cd <br /> U <br /> w Faslhyls Phoria: <br /> W tee.SFjn3Wre of A/Iernex Fadily(or Gaxre!W) IIIDay YM <br /> 4 <br /> 2 <br /> CD 18._Fpzymps lNasle.Repon MpMs9emem Mel9oP Copps,(i.e.,codas 1pr.Razerdpw tuna-x.neaVnaD4 dlsALmr•?L�u'A recyd®9r"Ys1Hns) __ <br /> pA IV 1 <br /> 20.OeIgnaled Facplry OwtMr or Operator.CMfttbn of raceipl of Iirerdous materials tos'ered by tea maMlost except r rated in Item tea <br /> Pr.NwfT,ped Name Signalum Memo D" Year <br /> C r,� lk"1-7 , z4 10', <br /> EPA Fomr 8700-22(Rev.3-05) Previous edlGons aro 0b5olela. DESIGNATED FACILITY TO 6ESTINATION STATE(IF REQUIREE <br />