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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 ;Irm r. 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST �1�,//►�" 1 1-800-424-9300 0 0 3 3 3 6 313 JJ K 5.Generator's Name and Mailing Addresoe0� / Generator's Site Address(if different than mailing address) 2-9 enerato s hone 6.Transporter 1 Company Name U.S.EPA ID Number Evergreen Environmental Services CAD982413262 7.Transporter 2 Company Name U.S.EPA ID Number B.Designated Facility Name and Site Address Everg reed oil, Inc. U.S.EPA ID Number 6880 Smith Ave. Newark, CA 94560 CAD980887418 Facility's Phone: 9a. 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)) 13.Waste Codes No. Type Quantity Wt.Nol. ve 16 Z 2. W 3. i 4. 14.Special-Hand ing Instructions and Additional Information it 15. GENERATOR'S/OFFEROR'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 i9temational 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 Acknow Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity g e )or( ;P-&-a-s-1>11 q ge tor)is true. Generator's/Offero�s Pnyped Name . Slg a M h D Year vni 1 (o 16.International Shipments i- ❑Import to U.S. ❑Export from U.S. Port of entry/exit: _ Transporter signature(for exports only): Date leaving U.S.: rY 17.Transporter Ack lodgment of Receipt of Materials uu oTransporter 1 P' dlTyped Name Signature , Mor D�Yep CL (` -0�f , rn Q Transp er f Printedrryped Name Signatufe Month Day Year t- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U < Facility's Phone: La 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) ui 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 PrintedlTyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)