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Please print or type,(Farm designed for use on elite(12-pig. .,yPawriter.) Form Approved.OMS No,2050-0039 <br /> _e#tTrZCRjn9 Nujiber <br /> WASTE MANIFESTCAL000337512 1 800 24 9300 CHEMTREC 060692-9 9 1 K <br /> 5,Generators Name and Mailing Address Generators Site Address(if different than mailing Address) <br /> AMERICAN PILE DRIVING EQUIPMENT, INC,. <br /> 7032 S. 1 SOTH STREET 29a5 Lcaomts Road <br /> KENT,WA 98032 Stooldon,CA 95206 <br /> Generators Phonvw.-174-Z91115�1151 <br /> 6,Trensporlor 1 Company Narrot U.S.EPA tO Nvrnger <br /> FREMOLJW ENVIRONMEWAL SERVICES INC_ Phone#800-559,3274 CARW0171017 <br /> 7.Transporter 2 Company Name U.S.EPA 10 Number <br /> 8,Designated Facility Name and Site Address EVERGREEN OIL INC, DAVIS U-S.EPA 10 Number <br /> 44561 ROAD 303 CADi)92446874 <br /> DAVIS,CA 95515 <br /> .Facilis Phone:510-795-4400 <br /> ge. 91b-U.S.DOT Description(including Proper Shipping Name.Hazard Cass,10 Number, 10.Containers 11.Tout 12.Unit <br /> HM and Packing Group(If any)) No. Type Quarrility 'NtJVol. 13 Wase Codes <br /> Non RCRA Hazardous Waste,Liquid(O[f.Y WATER) G 223 <br /> 001 -T-r <br /> 2. <br /> Jul <br /> ---------- <br /> 4, <br /> 14.Spa6dl HAndlint lrdttutli6nt and Adclitiontl information <br /> 1­12ndlers to be 4n hour trained and wear PPE <br /> !gbl) 4D-IL9 wA-V <br /> ERG#171 <br /> 15. GFNERATOR'SIOFFERO;Z'SCERTIFICATIDN; I hereby declare that the contents Of this=nsigrment artfully and accurately cl above by the proper shipping name,and are classified,packaged, <br /> marked and labeltdlplacarded,and are in all respects In proper conaftn fcrtwspor,,according to applicable international and national governmental regulations,If export shipment and i am the primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the Attached EPA Ackrov4dgrntnt of Consent. <br /> I cefoly that the waste minimization statement identified In 40 CPR 262.27(a)(if I am a lerge quantity generator)or(b)011 am a small quantity generator)is true. <br /> Gen ra s PrnfedlTyp"ame Signa urs Month Day Year <br /> 16, mlPments <br /> 11 import to U-S. ❑Export from U.S. Port of tritrylexlt: <br /> Transporter signature(for exports only); Date leaving U.S-: <br /> 17.Transposer AcknoMedgment of Receipt of ml <br /> U <br /> 0 P I <br /> ronsoorter 1 teaITY d Name Mono Day year <br /> CL L—T— <br /> Q'i- 1� pa — 16f 1 t <br /> Z TrBn3pcner 2 NntndlTyped Name Signature Month Day Yeir <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space CluaritityResmust Partial Rejection ❑Full Rejection <br /> Manliest ReferenCe NvmW; <br /> Aiternale Farifily(or GentrAlor) U.S.EPA 10 Number <br /> LL Focally$Phone: <br /> LQ18n.Signature Facility(or Ganer?jp-o Month Day Year <br /> Ll <br /> Z <br /> U5L) <br /> 19.Hazardous Waste Report Mandi Method Codes(i.e.,conles fnr hazardous waste treatment,disposal,end rtcyciing Systems) <br /> 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by N manifest except at noted in Item 1 So <br /> PnIlIdRyped Name Signaure Month Day Year <br /> Ll 3 <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. AT 4D <br /> ,FA 6ILI TO QZ:STINATION STATE (IF REQUIRED) <br /> Z00 'd NJ 91 : 10 H1 ZIOZ-K-W <br />