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JAN-10-1010 02:05PM FROM-EVERGREEN OIL 510-701-0126 T-730 P.001/001 F-103 <br /> • • <br /> Pleesepdntoriypa.{Formdesl0n�fauaeaf elite(12-pllch)rypewrllef.). �- � FortnApptbvad.OMB No,2050.008 <br /> UNIFORM HAZARDOUS� 1•GeneraloriONwrb� 2Pagclef '3.EmatgancyRegwnee Phone 4.•MeOnlfa.+Ot ckl umhor �� ��� <br /> WASTE MANIFF•S7 `Af'C.7 <br /> 5.Gonenats Name and Moan pallmas Ganamlads sllnAadrass(if rimeram Than matling eamal <br /> CEME X CONSTRUCTION MATERIALS <br /> WiasD S.TRACY ELVR. <br /> TRACY,CA 85377 <br /> Gehemlara Pn^ne: <br /> B.Tran.runert Campery I� nPAIDNumbcr <br /> EVERGREEN 5 RONMENTAL SERVICES CADg63418282 <br /> 7,Transponer 3 Canpany;vame U.S.EPA IO Number <br /> B.Oesgnand FtttRry Name and SlloAdtlrc's U.S.EPAIO Npmoer <br /> EVERGREEN OIWNC• CAD8E08s7418 <br /> N <br /> NEWARK CA 84580 <br /> FacillWc Phandl U-785.4400 <br /> 0 , gh.U.S,DOT DascripVm(Including Pmpa:Sb1i Name,Pleased CNse,ID NumIm, ts,Conl¢Inom 'N.Toal 12,UNI <br /> NM and Paamg Gmup(Ifa y)) No. Type Ouandry WILAU. 13.Most Codec <br /> ZZA <br /> z 2 <br /> W <br /> r9 <br /> 3. <br /> 4. <br /> i <br /> 14.spaoFW Nm�ktg itnW aluAdt$daael lydannepon _, <br /> PROFILE ERG <br /> 16. GENERATUR'SIOPFERORSCERTIRCATION:Ihereby dean first the opmsnts Mile catrimemnl an fully and acmrmoy dommind above by to rawBrAlpping name,and ere doasli paAoged, <br /> mafNed and 4balaaJplecar�d,end M In W mopcmb In Fmpor ooMllibn rorhmir➢prt azcardhp to applkablo mlemepadeM mdanal gpvemmeNd tegUagdns.RuxpodaNpmeMand I am the Pdmary <br /> Esptaba,I camry malthu mnla;ls o[d¢e carelgnlnent oadmm m Itw lemu otlhe eAacaerl WAAclmax'adgmamatCanaen!. <br /> icarllythal the waste mhtlndtaWn alatemenl wafted Alla CFR=a)(Irl ami large Wally genenllcr)a(0)(glem a smell qu Ipr)is men. <br /> Solara L PSAIed TWW Nanm S Mora Gay year <br /> D is InP S' <br /> —t I&Inlmnatlonal 5fdpnmas <br /> t— ❑ImponN U.S. 6inrtimm U.5. Pal of en <br /> Trefnponarstrareae for airports;Dory): Dow[ami' s: <br /> 17.TwilportarAcmowledgmenlOf Ramlplof Maladak <br /> � / J Slgna94 <br /> bm Md7gi Day Ywr <br /> tx mtuponer 1 PnnladR Name /!J/ <br /> a Lam' d <br /> Tranepwlar2 ,adliyped Name GI urd Monaf Day Year <br /> .I! 1S.Okaepency <br /> 1 Ion.DbuoPaM1ey lydltaUon Space ❑ quanlUy ❑Type ❑Reddua ❑PeNd RoJocllon ❑Put RoJoellen <br /> 11 ManNem Reference Numbar. <br /> lab,mormae Fedigy(a,Genaralo0 U.S,EPA 10 Number <br /> ua. FadWtys Plains: <br /> tan.Slgnaare al Monte Fe hy(tr Safar er). tan* 0aY Ywr <br /> 4 <br /> 2 <br /> 1S:NabltdCOa Wass Repan MaOagpmam M404 Callen Q4.,Chea farteral 9 NO wolfram,Aepoaar,and reeydm syelemel <br /> 0 1. x s, n. <br /> J 1L- <br /> 20,Dosbnamd Frailly Owner wOperator.CoNfitalbn afnculat al ha'rallous malebais cnverad by ata M2mloslexceptas tided In rom Ila <br /> ismordiTypod Name sgnence PMni.'t Day Year <br /> EPA Form 070o-22(Rav,3-D5) Prav aedNOnaareoblinfalm. D 1 TED FACILITY TO DESTINATION STATE(IF REQUIRED <br />