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* Generator,r_ Mail a copy to: DTSC P.O.Box 400 Sacramento,Ca.95812-0400 in 30 days. Please print or type,(Form designed for use on elite(42-pitch)typewriter) Form Approved,OMB No.2050-0039 UNIFORM HAZARDOUS 1 1• onerator ID Number 0 ` 2.Page 10 3.Emergency Response Phone 4.Manli Tracking Number WASTE MANIFEST c.J 1 1-800-424-9300 007038992 JJ K 5.Generator's Name and Mailing Address t r� /�A Gonorator's 8Ite Address(if different than mailing address) Ge era or's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number EVERGREEN ENVIRONMENTAL SERVICES OAD982413262 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address Evergreen Oil,Inc. U.S.EPA ID Number 6880 Smith Ave. Newark,Ca.94560 CAD980887418 Facllitys Phone: 510-795-4400 ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit HM and Packing Group(If any)) No. Type Quantity Wt.Nol.2. 13.Waste Codes W LU 3. 4. E t Jr I _II!T 14.Special Handling Instructions and Additional Aormation 15. OENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are'ully and accuralely described above by the propershipping name,and are classified,packaged, marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consIgnmenl conform to the terms of the attached EPAAcknowiedgment of Consent. I certify that the waste minimization statement Idenfified In 40 CFR 262,27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Gonerator'slOfferor's On dlTyped Na�mheA� Slgnai� Month Day Year 1 VVW f U- -1 16.International Shipments f— ❑'mport to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving US.: 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Pdnf ed Name01Signature Month Day Year 171 1/3Transport.2 Printedffyped Name s6hature Month Day Year 18.Discrepancy 18a.Discrepancy indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Refection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) US.EPA iD Number _J V ra Facility's Phone: 18c.Signature of Alternate Facility(or Generator) Month Day Year N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C3 1, ql`�/ 2. 3, 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in item 18a PrintedrTyped Name Signatur //M^^o��nth Day Year EPA Form 8700-22(Rev.3-05) Previous ed ions are obsolete, ATED FACILITY TO DESTINATION STATE(IF REQUIRED)RED)