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-- cormHNpiuv­ - <br /> s Nriier.) Number <br /> designed for use on eine(12 aitch, , 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking <br /> RDOUS 1•Generator ID Number 008 4 <br /> 3236 jJ' <br /> 7f 80042 <br /> d- <br /> ,e MANIFEST , eg 7: <br /> GeneratC>''s Site Address('d different than mailing address) <br /> _—,cors Name a AA js �L ` <br /> � . a yC <br /> �3 U.S.EPA ID Number <br /> aerators Phone <br /> .Transporter 1 Company Name CAD982413262 <br /> Evergreen Environmental Services U.S.EPA IDNumoer <br /> 7.Transporter,2 Company Name <br /> U.S.=?A IC Number <br /> 8.Designated Facility Name and Site Address <br /> EVERGREEN OIL, d CAD980887418 <br /> 6880 SMITH AVENUE E 5- 44 EWARK CA 94560 <br /> Facifity's Phone: 10.Containers 11.ToLI <br /> 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, _ No Type Quantity <br /> ga. and Packing Group(if any)) <br /> HM <br /> NON-RCRA HAZARDOUS WASTE, LIQUID ®01 � <br /> 0 <br /> - <br /> Z ' <br /> 14.Special Handling Instructions andAdditional Information Invoice Ld 3�C/ 13 <br /> PROFILE # Sales Order # <br /> DOT ERG#171 WEAR PROTECTIVE CLOTHING <br /> 15. GENERATOR'SfQFFEROR'S CERTIFICATION: hereby eclare that the conients of this consignment are fully and accurately described above by the proper shipping name.ono are.l s <br /> marked and labeled/placarded,and are in all respects in prop conhdetite for <br /> attached EtPAAcimoly edgment of Consenicable k national governmental regulations.ons.If e'.+port shipment a�f I am'^e <br /> Exporter,I certify that the contents of this consignment a Y=ar <br /> (dcnih Day <br /> I I certify that the waste minim¢ation statement identified_40 CFP.262.27(j)_ (if I am a large quanGlr,generator)or(b)(if I am a small quantity generator)is true. <br /> Signature <br /> y <br /> Gene rator'slOfferoI s Printedryped Name nY ' <br /> Export from U.S. Port of entrylexit: <br /> 16 Iny, to a Shipments Impoi;to U.S. Date leaving U.S.: <br /> fransporter signature(for exports only): - s. M ,,oar <br /> onth Doc <br /> W 17.1'ransporterAcknowledgment of Receipt of Materials Signature <br /> nsporter 1 PrintedlTyped Name Da 7 <br /> TraL /d <br /> O h ,. year <br /> hlon'h <br /> C1. Si awre <br /> Z Transporter Pn tedrryped Name <br /> d <br /> Ce <br /> 18.Disuepancy Fuli Rejection <br /> Type Residue Partial Rejection <br /> 1Aa.Discrepancy Indication Space LJ Quantity <br /> Manifest Reference Number. :E`PA ID Number <br /> 18b.Alternate Facility(or Generator) <br /> J �1 <br /> Day Year <br /> tai Facility s Phone: �1 <br /> W 18C.Signature of Alternate Facility(or Generator) <br /> Q <br /> . d Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 4 <br /> 19 Hazardous Waste Report Management Metho3. <br /> W 1 2. <br /> D ' <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 188 <br /> Month Day Year <br /> Printed/Typed Name <br /> PA1✓IL17 f TO DES 7.M3 740N ST,r i E 3N RC-)U <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. c � ;r <br />