|
NOV-18-97 09:45A EVERC-REEN - REFINERY 510 7116 2559 P.03
<br /> sa. d CPloro' .AR.zr See Instructions on back of page 6,
<br /> Fom ApP,e'Md Cma N..]030-00�91E.q.«v-loge) s«,ome.b.C.M.i:n
<br /> (r2P:wA)ryp....,.
<br /> 1. CMn.,ob,%US EPA 10 No. Monde..D«umeM No. 2. Pay 1 In(a.ma.an»..e.hed.d ww.
<br /> UNIFQRM HAZAR-OUSQ w noe,.�,,.d by F.d.,a d..
<br /> WASTE MANIFEST ' /'. zzI eJ I f of
<br /> o p./m.rpy'F�e(a d Mj&V Add,.,, 1_ G`.✓1 CA,Z4— -[.i A. slaw Man W 15 w 1 Nvmbe.
<br /> 96331795
<br /> w
<br /> S. Tn..poa.,I Campony Nam. d. US EPA Ip NumWr G. Sbw T,a,apoM,.U)
<br /> EVERGREEN ENVIRONMENTAL SERVICES DICI A]019 18 12 141111121612 _. T,e pow .P6o .
<br /> 7. Tr., r 2 Co.pa.y Ne1w. •. US EPA ID Numbw E. S.me T.o.pa,M't ID
<br /> n
<br /> V F. T,ompon.i.PMa,.
<br /> n Z 9. D.ipnmed F«iMF Nanc eM Si.e Add.m. H). US EPA ID Num W, G. Sww F.J ,'.
<br /> EVERGREEN OIL,INC.
<br /> 6880 Smith Avenue H. F«3dy.ft.
<br /> aNewark CA 94560 lCiAlW9191GA4171411187
<br /> V 12. CeNab..v 13. 1.1 II. Uro.
<br /> 11. US DOT O..riptbn(inc6dip P,op.r SAippi.p Nam..FWnnt Cba.,ab ID W-b.)
<br /> ? No. r G1 l ft W,/`/d L Won.w.b.,
<br /> x
<br /> N a NON•RCRA HAZARDOUS WASTE,LIQUID EPA/OA.
<br /> o E
<br /> 1 01011 TIT ml N b. sar
<br /> E
<br /> � R FPA/Cer,
<br /> A
<br /> as T saw
<br /> O
<br /> R EPA/00.,
<br /> .W-
<br /> 2 d. sow
<br /> U
<br /> W EPA/Cd.,
<br /> N
<br /> z A'AddknW O�V°f0'� roWs U�d Aba r H Coh.'br Wsw.Uv.d Ab.
<br /> N
<br /> W
<br /> R
<br /> <
<br /> Z
<br /> O 13. Sp.:al Hand"6..n.<wm.aid Adds nd bdormmw.
<br /> i 24 Hour Emergency Response Telephone No.:CHEMTREC 1.800-424-9300 Invoice t Sy 9G
<br /> W DOT ERG 31 WEAR PROTECTIVE EQUIPMENT
<br /> I& GINFUTOR'S CE[TIFICATION, I h..by d.6m trial N,e con..nw of dd.amp..wl w 'and«wnowfy d..rb.d obo..by prvp.r dupp6p.ome a,d a.e dowf.d,
<br /> < Pedmd,mmSed.mM 6W d.o.d en m A r.p.tw i,pep.,.o..d'nien I«n b
<br /> V aw,Pa^!Y id""oF«rn.dirq b apoicebk ive,naMawd vM b1ia„aI Qo..rmw,n rgAoYm..
<br /> _ M 1 w o 6.p.Wo•aF p.1�.m.r, I'•••Ib b..1 baw o p.oprew 6 p6..b,Mn.•.e.o6.me—d b "d .a.w 9•,..,d.d V d.dpr.. I K. d.mm-.d b br
<br /> c •.o•.�.�'Wa—bw aed.6a.I bw..I.rd Yw Wenk 4 m..6ed d fwn.v,. ,e9.,01 d.pobl w .wt,.666 b P..h,6 niw .n 4r p,..,.W
<br /> N Naim*b bre.6.% d..nwem,r:Ce,e 1 am a.r-A WmMlr pw.dw,I haw mad. a pond t.i .Ho,.b in.ieR. °7.a..e pnx.arion ab..kF d.. b..
<br /> g wmw m.Aod b i.awJob6 b ma and,6a1 I.aHadle I .
<br /> Cl P..a.d�p.d Nom.. Sgnvh,.. AbMI,
<br /> L [1
<br /> Z li. 7 1 d
<br /> (� . P,id•d ypd Nm..
<br /> K • • Menrh T.y
<br /> W 0 IL 2 A d R.w of AMwr6b
<br /> W 1 P.b..d/Typ.e Nm..
<br /> Q ! MaA. Dal' Y.
<br /> IY •
<br /> y 19. 0.,.po.ry M.ada.Spat.
<br /> < P
<br /> V
<br /> A
<br /> Z G
<br /> 1
<br /> 20. Ow. C«Kf o.r,d d hamrd. oew,W 1 Mb
<br /> t
<br /> ♦ w Ma.6 Der T.or
<br /> o �
<br /> _ 00 NOT WRITE !FLOW THIS UNE.
<br /> YA�t,rsc emsA (1/PA .o PO. &. 3000, «Camrde. CA 959T2OPY TO DTSC ��DAIS.
<br /> A
<br /> • 000 22
<br />
|