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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 erator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number �° WASTE MANIFEST 1 1-800-424-9300 003336314 JJ.® 5.Generator's Name and Mailing d ress Generator's Site Address(if different than mailing address) Gerferat�M1 one• 6.Transporter 1CVWffP9en�nvi ronmental Services I U.S.EPA ID Number @ @ CAD982413262 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site AddressEve rg ree n Oil, Inc. U.S.EPA ID Number 6880 Smith Ave. Newark, CA 94560 CAD980887418 Facility's Phone: 510-•795-4400 ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. elfd Of W ± L i t i I i S I i 14.Special Handling Instructions and Additional Information ��{{ 15. GENERATOR'SfOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,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 otLwsent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity genera or()Jif 1 a a a quanh generator)is true. Genera%fferor's Printed/Typed Signature Month Day Year —i 16.International Shipments - ❑Import to U.S. ❑Export from U.S. Port of entry/exit: _ Z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials oTransporter 1 Pri (Typed Name Signature Mont Day Year CL Ems— 2D f V) Transp er 2 PrintedlTyped Name Sigr4ture Month Day Year Q H 18.Discrepancy 18a.Discrepancy Indication Space Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number _J U u- Facility's Phone: 0 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 5-5 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) p 1.. 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 PrintedfTyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE, OF REQUIRED)