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�u...».�»; per:,. - u..----�Iiiir-•--�-." <br /> --Pre-a§It or type.(Form designed for use on elite(1 )typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Genera r ID c 't _ Z Page r <br /> of 3.Emergency Response ,one 4.Manifest Tracking Number <br /> WASTEMAW>"T � / `�/ 1 1-8004249300 006661369 JJ K <br /> T Generators Name and Mailing Address Generalor's Site Address(if different than mailing address) <br /> 7rF <br /> Generator's Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Evergreen Environmental Services CAD982413262 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Evergreen Orf, ;nc. - — - - -- <br /> 6880 Smith Ave. <br /> Newark, Ca.94560 CAD980887418 <br /> Facirdyrs Phone: 510-795-4400 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID NumLA,r, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity yytryN,Aw <br /> 13.Waste Codes <br /> I <br /> q/ - <br /> 4. <br /> i 14 5eiaIH andliri Instructions and Additional Information <br /> -;s-�.•-- <br /> 1 <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that ihr inter' !hicor>atgnmer are filly and accurate v;ascribed above by the proper shipping—r nd EraAr.;,.fled oaekegr <br /> markW and labeled!placarded,and are in all respects in proper condit. i ns x:-ding t,app able international and national goyernmental regulations It export Oir, .at and I ani the Prima.y <br /> Exporleir,I•Aifythatthe contents of this consignment conform to t ;e at -EPAAcknoA-,-:4 vent of Consent. <br /> I cerbTy that the waste minimisation statement identified 0 4.CFR 202.L l a;,;;:drge quen*gene-inr)or(b)(if I am a small quantity generator)is true. — <br /> Getieo,W91Ofterces PrintedlTyped Name i Signature Mont Day Year <br /> a 16.InIlemational Shipments <br /> Import to U.S. _ xport from U.S. Port Pf nntrylexit: <br /> Transporter sb;;:aature(for exports only): ,—� D"1-leavi:'g U.S.: <br /> V 17.TtartsporterA;knowledgment of Receipt of Materials <br /> Tr,Y epoder Priated(fyped Name Si Month Day Year <br /> Aly <br /> i" Signature <br /> Month Day Year <br /> ns�nnor 2 i'Iir^edffyped Name 9 <br /> - - --- �- __1_ - -- - _ r, I L j <br /> ,,crepancy 1 <br /> r 18a. wcrepancy indication Space El Quantity ❑ :A L. Residue Partial Rejection .'I Rejection <br /> 18b.Atte. Manifest Refe once Number.ate Facility(or Generator) U.S.EPA ID Number <br /> It Facility's <br /> -Phone: <br /> 18c.signature of Alternate Facility(or reneratorj Month �f)ay Year <br /> Q <br /> U, 19.Hazardous Waste Report Management Method Codes(i.e.,co r hazaru.,is waste treatm ,disposal,a,d recycling systems) <br /> 01, 2. ytY/ 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 188 <br /> rdfTyped Name Signature Month ay Year <br /> _L1'0' it, . <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED, <br />