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"Generatorpail a copy to:DTSC,P.O.Box 400,Sacramento,CA 915812-0400 within 30 days A" Please print or type.(Form designed for use on elite(12-pltch)typewriter.) Farm Approved.OMB No.2050-0039 i.Generator ID Number 2.Pae 1 of 3,Eme enc Response Phone 4.Manifest TrackingNumber ) UNIFORM HAZARDOUS 9 nJ y p 1009437814 JJK WASTE MANIFEST CALOU0183938 1 �-BQD-424-93fl0 5.UeArrator's.NName and MalinAddress Generator's Site Address(if different than mailing address) WIPIPORTATION U. OCO C 05 Generator's Phone: X09-485-2fl0© �- � �� ,,.,' 6.Transporter 1 Company Name US.EPA ID Number EVEEEN ENVIRONMENTAL SERVICES 11 IN 1 9 2w CAD902413202 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number EVERi�`REEN OIL, INC. larPT-IJ^CDAOTAACf l - G880 ITH AVE. CADMON7418 NEWARK CA 84560 Facility's Phone: X510-7854400 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 Not. 13.Waste Codes o 'UNI t3,WASTE FLAMMABLE umins,N.Q.B„3,II(GASOLINE, 213 D001 D01a DIESEL) DM 1"164 LU _01A1 Ceps 3. .,.......... ..,...w....�M.......... 4. i 14.Special Handling Instroctfons and Additional Information A.77786 ERG'128-9b1 !l!/v�9�S'er --o?)e 1 p Document# 8.777,W /7/ —042— 132280 l 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper sgipping name,and are classified,packaged, marked and labeledlplacarded,and are in all respects In proper condition for transport according to applicable Interratlonaland 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 certify that the waste minimization statement Identified In 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(If I an a small quantity generator)Is true. GMn@rafo ffero`' PrintedfrypedName sigr)re ^ may Motll� y Year rJ 16._IInnttteernatio IShr1ipments UPJ\ lr�i (�)! w z ❑Import to U.S. ❑Export from U.S. Port of entrylexlt: Transporter signature(for exports only): Date leaving U.S.: 17.TransporterAcknowledgment of Receipt of Materials Transporter 1 Prirtedl typed Name Sig y� Morth Day Year 0 CL Transporter 2 PrinteCyped Name Signature Month Day Year F- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantic ❑ I ❑Full Rejection Quantity Type ❑Residue Partial Rejection Manifest Re`erence Number 16b.Allernato Facility(or Generator) U.S.EPA ID Number J U W Facility's Phone: 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z w19.Hazardous Wastes Report Management Method Codes(i.e.,codesforhazardous waste treatment,disposal,and recycling systems) G 1 Hlyl 2 1 / 3 4. f 20.Designated Facllity Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a anted/Typed Name! Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. ATED FACILITY TO DESTINATION STATE(IF REQUIRED)