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**Generator,Mail a copy to: At" P.O.Box 400 Sacramento,Ca.95812-0400thin 30 days.* Please print or type.(Farm designed for use on eilte(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS f•Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST I;Vi `7' 3 0� 1 1 800-424-9300 008643998 J J K 5.Generators Name and Melling Address rGenerator's Site Address(if different than mailing address) i�s"f��> r✓i�'�fi�� ' Generate s Phone: 6.Transporter Company Name .S. PAID Number Ever reen Environmental Services GADg82413262 7.Transporter 2 Company NameU 1 O15 U.S.EPA ID Number 8.Designated Facility Name and Site Address ENVIRONMENTAL EPA ID Number Evergreen Oil,Inc. 6880 Smith Ave. 14r-Al rrJ nceAaT49cn1T CAD980887418 Newark,Ca.94560 Facility's Phone: ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes i HM and Packing Group(if any)) No. Type Quantity wt.Nol. ac � LLI LLI -7 3. 4. 1 pecial ntlli—Ins coon and Additional Information / f ,IJ �f�� a�� .°�+•�.— � V-,?-� 7779�6 15. GENERATOR'SIOFFEROR'S CERTIFICATION; I hereby declare that the contents of thls consignment are fully and accurately described above by the proper sNpping 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 consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minbnization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)Is Irue, Genemtor'slOfferor's ted/Typed NameSI Month Day Year a Otr -1 16.International hipmenis F ❑Import to U.S. Export from U.S. Pori of enirylexlt: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporte 1 PrintedlTyped Name Signaturo Month Day Year �� .a \ .ear"' • ap.w.-�"ti Z Transporter 2 Primed/Typed Name Signature onth Day Year a x 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Refection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number U LL Facility's Phone: In W 18c.Signature of Altemate Facility(or Geiorator) Month Day Year a z 19.Hazardous Waste Reportt Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 01 / 2 141Lt1 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Signatu Month Day Year PrintedlTyped Name � G © 1 9 r EPA Form 8700-22(Rev.3-05) Previous edition re obsolete. ATEU FACILITY TO DESTINATION STATE(IF REQUIRED)