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;ase print or type Form designed for use an elite (12-pltch ewriter.) UNIFORM HAZARDOUS 1. G =tar ID Numhar 2 Page 1 WASTE MANIFEST / S. Genermccs Name aMf Mailing dyes ere s?hone: 6. TranspCyer 1 Comperry Name Evergreen Environmental Services Evergreen Oil, Inc. 6850 Smith Ave. Newark, CA 94550 . acinry'a Pliant: 510-795-4400 9a 9b. 0.5.00+ Dasepton ondu7n9 Proper Sh!pping Name, Hazard Class, ID Number, HM and ?aokingGroup(eany)) kZ S Form Approved. ONIS No. peney Reapense Phone a, hfanlfestTratkinq Number z-soo-ata-93oo 002390158 J, F4, 3paClal Handong Irath;l0 iO�ns and Ad'20,lel laformsllcn ��`�' /Z?_1 15, GENERATOR'SIOFFEROR'S CERTIFICATION I hereby dadaro that the Contents of the eons!Vram are My and aGurately degzribed above by the prooers)tpping name, and ani a =Haled, packaged, marked and labeledrptecerded, and aro In all re=ac`5,tn pr°pat condlllon for transport a°eardlng to apotcable international and national govarranantal regll20rm If aport shipment and I am the Primary Ex;orter, I ornly that 01e =tort o` this eormtrimetlt conform to the farms of the attachad EPA Adalarvledgment of Consent I certify that I}ie waste mlAmlzallon slaromant Ideaflflad !n 40 CFR 262.27(a) pt't am a lerce quartty genarstor) Or @j Oft am a stndl quantity generator) Is Inas, 3e15ra emes Pdntedlryped Name 3nelu htoctn gY Yaat% IN1 fnaVonat Shlpmenta � lmpart to US' ❑ � Pcft it m U,S• Poll of entrylexlt Trantsporter signature (far exxna nn:y): Data leaving US.: 17. TranspaterAftVMedg2nt of Raoel.'pt of Matedca Rarwporter 1 Printedrr ams SlgnelLTa Mon aar� . /Azlw- 18_ Discrepancy 189.OLscrepancy Indiction Space ❑ Quantity ❑ Type ❑ Pestdue ❑ Peal Rejectian ❑ Ful Relecrlan ManAst Reference Number, 13AittxnsteFeally(orGenerator) U.S. FA10Numbar 1, 1 V rai Fadltys Ftasna W lea Signature afAlremeitityala Fa(cr Generalori Month ay Year Q 2 19. Hax2rdoua Waste ReportManagement Matnod Codas O.C. codes tr hazardous waste IraaImant, disposal, and raCyCilng 3ySla15) LU 1 3, a, 2Q. DaSolled Fact3y Owner materials ccver£d W the merifest excepr as nded in Tran i9a rntedliyped tvema�.�e � ISraNra Month By Year � cr�a�og A Forrn E700-22 (Aev. 3-W ?reviotu sdlflons are obsolete, n a-r=n =A till aro Tn ng;zTtntaTinm csnTt= fly R70J URE(?) £00 'd Ed E£: IC NOE 1102 -H -151V CAD982413262 U. S- EPA M Number U.S. EPA ID Ntnber CAD980887418 10. ConWn=_rs 11- Total 17- Unll 13.'Na E� Codes No. I Type QuanSy WINOi. 133 6" 1 -3o (q- F4, 3paClal Handong Irath;l0 iO�ns and Ad'20,lel laformsllcn ��`�' /Z?_1 15, GENERATOR'SIOFFEROR'S CERTIFICATION I hereby dadaro that the Contents of the eons!Vram are My and aGurately degzribed above by the prooers)tpping name, and ani a =Haled, packaged, marked and labeledrptecerded, and aro In all re=ac`5,tn pr°pat condlllon for transport a°eardlng to apotcable international and national govarranantal regll20rm If aport shipment and I am the Primary Ex;orter, I ornly that 01e =tort o` this eormtrimetlt conform to the farms of the attachad EPA Adalarvledgment of Consent I certify that I}ie waste mlAmlzallon slaromant Ideaflflad !n 40 CFR 262.27(a) pt't am a lerce quartty genarstor) Or @j Oft am a stndl quantity generator) Is Inas, 3e15ra emes Pdntedlryped Name 3nelu htoctn gY Yaat% IN1 fnaVonat Shlpmenta � lmpart to US' ❑ � Pcft it m U,S• Poll of entrylexlt Trantsporter signature (far exxna nn:y): Data leaving US.: 17. TranspaterAftVMedg2nt of Raoel.'pt of Matedca Rarwporter 1 Printedrr ams SlgnelLTa Mon aar� . /Azlw- 18_ Discrepancy 189.OLscrepancy Indiction Space ❑ Quantity ❑ Type ❑ Pestdue ❑ Peal Rejectian ❑ Ful Relecrlan ManAst Reference Number, 13AittxnsteFeally(orGenerator) U.S. FA10Numbar 1, 1 V rai Fadltys Ftasna W lea Signature afAlremeitityala Fa(cr Generalori Month ay Year Q 2 19. Hax2rdoua Waste ReportManagement Matnod Codas O.C. codes tr hazardous waste IraaImant, disposal, and raCyCilng 3ySla15) LU 1 3, a, 2Q. DaSolled Fact3y Owner materials ccver£d W the merifest excepr as nded in Tran i9a rntedliyped tvema�.�e � ISraNra Month By Year � cr�a�og A Forrn E700-22 (Aev. 3-W ?reviotu sdlflons are obsolete, n a-r=n =A till aro Tn ng;zTtntaTinm csnTt= fly R70J URE(?) £00 'd Ed E£: IC NOE 1102 -H -151V