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nb=Environmental Protection Agency <br /> + e .,wd OMB No.2050-0039(Expires 930-94) See Instructions on bock a 6. Department of T..k Substance.Co., <br /> rr'w or type. Form designed for use an elite ff2pdc or Sacramento,Cnld.mi. <br /> UNIFORM HAZARDOUS 1. G°"°rotor's US EPA ID No. Manifest Document No, 2. Pogo 1 Information in the shaded areas <br /> WASTE MANIFEST <br /> is not required by Federal law. <br /> � �j � 3 C �' of 1 <br /> C 3. Generator's Name and Mailing Address ',CE'Ce S /y.f of <br /> 5Re stshbef e ! x: <br /> ��?�y. <br /> m4. Generator's Phorm ( <br /> S. Transporter 1 Company Name - 6. US EPA ID Number '^Ttgnspo.' ac k ' <br /> $ EVERGREEN ENVIRONMENM SERVICES s " <br /> 7. Transporter 2 Compony Name S. US EPA ID Number <br /> U <br /> 9. Designated Fwility Name and Site Address 10. US EPA ID Number <br /> O o EVERGREEN OIL,INC <br /> 8580 Smfth Avenue <br /> a Newark,CA 84560 ICIAID1918 0 8 8 7L41 118 a s <br /> u <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containen 73. Total 14. Unrt <br /> Co 2 P C 9 P PPi^B s <br /> No. Type OuanWt/Vol <br /> v W T wry' <br /> E NON-RCRA HAZARDOUS WASTE, LIQUID 0 0 1 T I T 13 G EPF3Ey z :y <br /> 00 N <br /> C? . <br /> N R EPAj,Ofl)er : <br /> V <br /> m T c SfSTg _ + <br /> J. O - <br /> Z d. <br /> W rl �•. <br /> U r <br /> 5 av <br /> 1111111 I <br /> ., 1115 <br /> � _ <br /> , <br /> _. <br /> 15 ectal h dlin Insirvcnonz and Addis anal Information <br /> 1�EMERGE�iICY <br /> Z CALL CHEM+:TREC <br /> 1.800«124-�3pp � <br /> DOT ERG 31 WEAR PROTECTIVE EQUIPYEi T <br /> 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and ore classified, <br /> Qpocked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable Iederol,state and international laws. <br /> U <br /> If I am a large quantity generator, 1 certify that I have a'program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to mewhich minimizes the present and future <br /> ar, <br /> N threat to human health and the environment; OR,R 1 am a small quantity genereI have made a good faith effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that I can afford. <br /> Q Printed/Typed Name / - Sigrwture Month Day Year <br /> Z T 17, Tr iter 1 Acknowledgement of Receipt of Materials i^- <br /> w e <br /> w Prince T d Na a s� Si na <br /> s ��A,�v 9 h!><� / Month Doy Year <br /> P 117 <br /> ly <br /> wv 16. Trans orter 2 Acknowled ement of Receipt of Materials <br /> E Printed/Typed Name Signature Month Lay Year <br /> LL <br /> O e <br /> 19. Discrepancy Indication Space - <br /> Q F <br /> U A <br /> Z C <br /> rPr , <br /> cili O«ner or O erator Certification of recei t of hazardous materials covered b this manifest exec t as noted in Item 19. <br /> T /Typed Name Signature Month Day year <br /> Y - - - <br /> DO NOT WRITE BELOW THIS LINE.' <br /> DTSC 8022A (7/92) ` ✓/�. <br /> EPA 8700--22 / Yellow: GENERATOR RETAINS <br />