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—Generator,- Mail a copy to: D7 P.O.Box 400 Sacramento,Ca.95812-0404hin 30 days.** Form Approved.OMB No,2050.0039 r, eas, intor type.(Form designed for use on elite(12-pitch)typewriter.) 2 page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number ��1.Generator V Number FURM HAXARQOUS � � � ,Gy 1 800424-9300 008642948 WASTE MANIFEST G Generator's Site Address(if different then malling address) 5.Generator's Name and Melling Address HEGEIVEr,"I Generator's Phone: '� ✓�`� � U.S.EPA ID Number 6,Transporter 1 Company Name 2 015 CAD982413262 E=Ver reen Environmental Services JUN U.S.EPA ID Number 7.Transporter 2 Company Name ' U.S.EPA a.Designated Facility Name and Site Address rgr_�r�f�nGDAOTgpCNIT ' Evergreen Oil,Inc. CAD980887418 6880 Smith Ave. Newark,Ca.94560 Facilit Is Phone: 51 n-7AR-4400 9a. 9b.U,S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11,Tatal, 12.Unit 13,Waste Codes HMand Packing Group(if any)) No. Type Quantity Wt.Nol. LU 2 •ql�,v s�''�.� "rl�i`5ldlI � .S�a/.�°° 0 3. r 4. 14,Special Handling Instructions and Additional Information 71 15. GENERATOR'SfOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shippirg 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 EPA Acknowledgment of Consent, I certify that the waste minimization 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 true. Month Q Year Gener slofferoesP'tedlTyp Name SI [nt II tl b 1 16.Intematlonaf Sh pments ❑Import to U.S. ❑Export from U.S Port of entrylexit: Transporter signature(far exports only): Date leaving U.S.: ac 17.TransporterAckaoWedgment of Receipt of Materials Month Day Year Transporter 1 Printed/Typed Name Signature O / - a Transporter 2 Printed/rypod Name Signature Month Day Year a f- 18.Discrepancy 19a.Discrepancy Indication Space quantity ❑Type ❑Residue ❑Partial Rojectlon ❑Full Rejection Manifest Reference Number: U.S.EPA ID Number 18b.Alternate Facility(or Generator) L) L Facility's Phone: Month Day Year W 18c.Signature of Alternate Facility(or Generator) Q Z y 19.Hazardous Waste Report Management Methi7&/ dids for hazardous waste treatment,disposal,and recycling systems) 3. 4' 0LIJ 1. fel l Lt 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Month Day Year PrintedFryped Nam Signature EPA Form 8700-2.2(Rev.3-05) Previous a ions are obsolete. ATED FACILITY TO DESTINATION STATE(1F REf.IUIRED}-