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MAR-19-2010 10:39AM FROM-EVERGREEN OIL 510-791-0126 T-070 P.013/017 F-32T <br /> P11 Se print or •IF desgded IDr use on alto(12-p.-• titer.) Form A ed,OMS NO.2050-0039 <br /> UNIFORM NA2ARDOUS t. raw ID ° r 2.Page 1 of 3,Emergondy Response Pnone e.Meedast TrrW*Inq Number <br /> WASTE MANIFEST - 1-300-424-9300 0025-85709 JJ K <br /> S.Gnemmys Name ono Mabry Addr Generamr's Sae Aderess(sl amererp than moans atltlrees) <br /> Genxamre f+Inne: <br /> 5.TriI Company Name U.S.FPA ID Number <br /> Evergreen Environmental Services CAD9824 <br /> U.S.EPA l0=1 3262 <br /> 7.TranspMer 2 Company Name <br /> B.Deslgnmid Factllry Name end SiteAddreasa U.S.EPA ID Numbor <br /> Evergreen Oil,Inc. <br /> 6880 Smith Ave. <br /> Newark,CA 94560 <br /> Fade S Pnono 510-795-4400 CA 98089 7416 <br /> 9, 9bU.S.DOT Dacrpuon(eraudns Prepor alpo"Name,MWara Class,ID Numox, t0.ConraMels <br /> hM and Pxldng Gmdp(If STA11. 12.Unit 13.Waste Cedes <br /> 1 No. Type 4uanfityih Wad. <br /> Y 2 <br /> W <br /> r.7 <br /> 7. <br /> A_ <br /> id.Special Nand6 rb ucD and Addiliom1 I _ <br /> 7T7 <br /> ERa <br /> RATOR'W PEROR'S CERTIFICATION' Ie liylrce9iopeisNppng name.and areGnsellled,paclmgcd,and IebHadlpiaCaNedantl erein aecmmenlU regukdma I1 ixpol 3hlpmenl and I am IM Pdmery <br /> er, candy IIaI mu ran;DnlS o!Inlstey tiler eie wears mlNmizaamt Nendfiea In 40 LFR 25227(e)(f am a large quamih erwramrj or h) a m a amn tlnerator)is woe. <br /> or"no's PHjwi7M Name Mmdn Day yw <br /> ane1 Snipmano, I padtou5epnaWm(tor exp«ta only)narAJcluwledgmenl al Recept of Melenela <br /> Tranapondr 1 P ypae Hama SlgnaWra Mond) Day Vex <br /> �rIM <br /> a -;IL„t77 <br /> < Tran nut Prinoulyped Name Signa Monlh Day You <br /> a <br /> r <br /> 18.Dlurepency <br /> 18a.Dk Wancy Indii Spaco ❑ DDanaty ❑TYpe {,_I fiesldu ❑pamlal Refection ❑Fa PA'p n <br /> Manifest Reference Number. <br /> 1Eb.Ahumate Fealty(01 GDaaralpr) US EPA ID Nurnoer <br /> V <br /> LL I'WH 'a Phone: <br /> ide5iip of Alternate Fudley for G9w3lec) MDelh Day Year <br /> K <br /> z <br /> H19.fluardoue Waste Rai.Management Mcrhod Codes(l.e.,codes for hazardous waste moat mom.thposal.and racydinp sysWms) <br /> m 1, <br /> n ��I <br /> 2D.Deignaled FadlRy gmaror Opaabr.CeNflcad n of n ipl of hnzarddsa M10419 roared by em mani accept as now In dem 18a <br /> Priv sped Neme SKnetdra _ Mandl Day you <br /> EPA Form 8700-22(Rar.3-05) Provlous oeitions are obsolete. DESIGNATED DESTINATION STATE(IF REQUIRED) <br />