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Please print or type.(Form designed for use on elite(12-p__..,typewriter.) Form Approved.OMB No.2050-0039 <br /> j UNIFORM HAZARCOUS 11.Generator ID Number 2.Page 1 of 1 3 ?memency Response'-'one 4.Manifest Tracking Number <br /> MANIFEST1641Q 00- z 1 ft800-424-9300 008642573 JJ K <br /> 5.Generators Name and Mallin dap d=enerator's Site Address(if different than mailing address) <br /> of 1 � � <br /> G tors^hone: <br /> 6. ,'!nsponer 1 Company Name , U.S.EPA ID Number <br /> ' <br /> EverpreelT Environmental Services CAD982413262_ <br /> 17.Transporter 2 Company Name I U.S.EPA ID Number <br /> ignater ility Name ar,d Site Address R�~ _ _ U.S.EPA ID Number <br /> vergreen r,,*[,inc. <br /> 8880 Smith Ave. CAD980887418 <br /> Newark,Ca.94560 <br /> t eh:a 6,i n_�Q�_aann _ . <br /> is3 Rx U.S.DOT Description(including Proper S''it:ing Name,;+azanf Class,ID Nu, »r, ! _ 'i'�.c•�una—k,tw^s 11.Total 12.Unit 13.Waste Codes <br /> w i's�A ff and Paddng Group(if any)) ~Np, f TyFm Qu rattly WtNol. <br /> rop <br /> 75 ( <br /> 14. <br /> Ii.Special dandling IIn'structions and Additional Information <br /> ? <br /> 95. GA RA7 UR QrtGPFLttQR'S GERTIFICATM: 'herby declare that the conte s co::sgnmeM are frill -,�jtnwely desr 111bod at,*a by the proper chipping name,and are aossiflerf rackdgari, <br /> rnadced wind kbelddlfilacardod.and.a-e in all resp3.!s In proper coeidigon for tr^ _cP,-iing w applicable intr:r,.tionet and aefra:,,i er vr. 5ais.If export shipment aWl am the r ima,,y <br /> Fooaor,I aer iry that the conterifs of Uns cc^sig4tl ht comam to the terns of ltd y:,.het l_PAAcknowkc'tgment of Cottserit. <br /> I rfy met ttiew;3olo milrilhuzation statement identified In 40 GFR 262.27(x)(if i ern a large yore"gfift oto:)sr,;hI fir i a:.:a small 4. toner is,9J@. <br /> Plk7fedFTVDEd N:sme """" furs T... ........�.� .�•-"••� McnihJ Day �o:u <br /> 7 <br /> h <br /> . 16.''te't,..: i iipments Ernport tq U.S. ExpClt arorl <br /> ,„l Shue(fore) leaving U : <br /> �. _. <br /> a i 1.`C 14p0&1r&l rk)vv . it of Receipt of"Aawrials - <br /> .aaMM:rbr i eiT w <br /> Name <br /> s_"..ti ianth Oay Year <br /> 4;alnyxxfer yP2d. Sigret� , Month Day Year <br /> 4� <br /> f al Rx c6on <br /> Clftcrepxr:;y I'dha,Hon� ^Hty ❑Type Hon !e <br /> iob..^ntemate Facility(u �,. ,aior) U.S.EPA ID Number <br /> rTty's Phom: _..�., <br /> Ujj, 8.-V ,nature oftemnre Facility(or Generator) Month Day oar <br /> ` <br /> Ii <br /> 19.Hazardous Waste Repod Management Method Codes(i.e.,codes for hazardous waslo c:fitment,dispose:, Ging sy, iis) <br /> C1 2 3. 4. <br /> vn Designated Facility Owner or Operator.Cert cotton cf receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> f'rmtedfTyped Name - nati- Day I Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGM ED rACI L I T Y TO DESr IMA:T 10 I.5 ST,47E(IF R E 0 U I R E <br />