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MArc is-aUIU 10:36AM FROWEVERGREEN OIL 510-791-0126 7-070 P 003/017 F-327 <br /> Please pdpt or type.(Form doslgned far use wattle(12-pitch)typewriter.) Fan Approved.OMB No.2050.0039 <br /> UNIFORM HISAROOUS1• r/L7 1 1 7!r`' l 2.PaBo t of 3.Em MoncyRospolsa Phan 4.Manifest Tra rg Numhor <br /> WASTE MANIFEST ( v 1 1-800-4249300 002390204 J J K <br /> S.Geramtofs Name end MNPng Address e Generators S38 Addms6(e dlgorenl Inert mailing monies) <br /> Ge M I1t 0 <br /> 6,TMnWwf 1 Canpory Name U.S.FPA ID Number <br /> Evergreen Environmental Services CAD982413262 <br /> T Tmrreponer2 canparry Name u.s.EPA lO Number <br /> 6,Oeveflaad Maly Name and Sha Addracs U.S.EPA IO Number <br /> Evergreen 011, Inc. <br /> 6850 Smith Ave. <br /> Newark,CA 94560 <br /> ra Y5 Plane; 510-795-4400 CAD980887418 <br /> 9% ab.U.S.DOT Deaaip6cn(Induding Proper Shipfang Name,Hazard Gane,N rimboa 10.Canto a 11-TOW 12.Una 17.Waste Codes <br /> HM and PazJring Group(Ifarp0) No. Type Quenthy WLAteL <br /> � 2 <br /> N <br /> 9. <br /> 4. <br /> 14.Special Handhap b1GINd1anG role aNail91 Inlonmlion <br /> /`C/ /7 / <br /> 16. GENERATOR'NOFFMR'SCERTIRCATION: I nereby dadaa that the mnkeec oftN5 conagnmaot am Wy and aeouretaly described ebeva by the papereNpping name,end are classified,packaged, <br /> marlmd and WD)Ddrpatarded,and win all respects In pmpa condmon for tampon ecoaranG to applicable Intentional and national govammanial mGutellahs.If export shipment end I am the Primly <br /> Exporter,I me*that the orients of ibis canslarenenl conform tome lanes or the Owned E PAAcknowlodgmonta?Cansem. <br /> l mdlfy Omt the wage mInItroatbn Natemnl IdentIfed In 4D GFR2B2.27(5)(If I am a lige quauly gererotor)or(b)(til me amell gmnilly genaralor)Is we. <br /> CeneMed0gaafe PrIntu ffyped Nome "Una a Month Day Your <br /> /� !� A / <br /> �r 16.In dont Shlpn s <br /> aniwd to U.S. ❑Expomfam U.S. Pat of amtryredt <br /> Tramppmervitmaja(for exports ad# Data leaving U.S.: <br /> 17.7anaporterAeNropkdgm ni ofRemipl of Materials <br /> x 7rerlspdner 1 Prom ped Nertto sgrahsa. Mmrlh Oaf Year <br /> a <br /> 0 <br /> za 7nmsAs Z Frh*udVTfp6d Ndmb51gofta Muds Day Yaar <br /> 19.Disampmcy <br /> 1N.Ulsoepency Indication Space �-y <br /> ❑ Qgantiy t�✓J Typo ❑Residua ❑PariWiRejection ❑FuA RDIocBa1 <br /> �QZ GI le'r 24 1pMannar Referenca'Numban <br /> tab.Momale Facylty(or GonamroN U.S.BPA ID Number <br /> ra+. FeOkYs Phone: <br /> 4W Ida.SbmexaafAhBM Fat car Ganoralor) Hecate rby Year <br /> 2 <br /> 19.HraardoUG Wash Repoem <br /> t Management Melnod Codes[IA..codes forhazadouswasle Imairnene.disposal,and acyaling system) <br /> 1. <br /> l'fl z Ji l`f l a 4. <br /> 20.Designated Featly Omer or Operator.Ceacafian at receipt of hazardous maur®Is covered by the mardrestexcept as road in Ilam lag <br /> PrmledfTyped Name L 9 Monro Day Yeer <br /> aWm /J J1 OK <br /> EPA Fane 8700-22(Rev.3.05) Preriw5 ed na are obsolete. ATFn Farm rrY Try nF.STINATION STATE TIF REQUIRED <br />