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S <br />S <br />U <br />3 <br />t- <br />L <br />v <br />a <br />C <br />L <br />a <br />LL <br />L <br />0 <br />LLLL <br />LLC <br />LL <br />v; <br />C <br />L <br />�2 <br />State of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-99) <br />Please print or type.Aform designed for use on elite (12-pirch) typewriter. <br />See Instructions on back *age b. Department of Toxic Substances Control <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) While. TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS, <br />EPA 8700-22 _ _ _ _ _ To, P.O. Box 3000, Sacramento, CA 95812 <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />AIIIolacd ® <br />of 1I <br />is not required by Federal law. <br />EES4 <br />. e ro Nam r�M9iIin9 A dor c �� <br />/C..�- �f `// J <br />A. State Manifest Document Number <br />- 2 7 <br />�95�i sa ]ahs, 3, <br />B. State Generator's ID <br />n <br />n <br />A. Generator's Phone ( ) - 14 Z <br />5. Transporter 1 Company Nome 6. US EPA ID Number <br />C. State Transporter's ID IReservod:] <br />EVERGREEN ENVIRONMENTAL SERVICES <br />CAD 4 1 <br />D: Transporter's Phone 800) 972-5284 <br />_ <br />7. Transporter 2 Company Name - <br />P p y 8. US EPA ID Number <br />� E. Stare Transporter's ID [Reserved.]. <br />J <br />_ <br />P. Transporter's Phone <br />9. Desi noted Focili Name and Site Address 10, US EPA ID Number 'Cr. State Facility's ID <br />i <br />EVk�RGREEN �IL, INC. 19 ;7 4 8 <br />6880 Smith Avenue <br />H. Facility's Phone, <br />Newark, CA 94660 CAD 19. 18 10 18IS(510) 795-4400 <br />11 18 1 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />14. Unit <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />i:. Waste Number <br />a' 0-1 14yy 9ASTE, <br />State '*y Z j <br />NON-RCRA HAZARDOUS LIOU <br />EPA <br />fhb <br />G <br />®1 <br />T T <br />G <br />E <br />N <br />6' <br />State <br />i E <br />- <br />EPA/Other <br />R <br />r A <br />> T <br />c <br />State <br />i O <br />_ <br />EPA/Other <br />R <br />i <br />d. <br />Stat® <br />3 <br />t <br />EPA/Other <br />t <br />t <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes Listed Above <br />t <br />o. b. <br />f <br />( <br />c: <br />d. <br />15. Special Handling Instructions and Additional Information <br />24 Hour Emergency Response Telephone No.: CHEMTREC 1-800424.9800 Invoice # <br />DOT ERG 171 WEAR PROTECTIVE EQUIPMENT Sales Order # , <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipp ing name and ore classified, pocked, <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and notional government regulations. <br />If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />practicable and that I hove selected the cticoble method treatment, disposal <br />pro of storage, or currently available to me which minimizes the present and future threat to human health <br />and the environment; OR, if I am a small quantity generator, I have made o good faith (fort to minimize my waste generation d select the best waste management method that is <br />a ilable to me and that I can afford. <br />Print ped a ® <br />IYe <br />Signature <br />t D <br />R17. Transporter I Acknowfed emeni of Recei f Materials <br />NPtint�Typed <br />Name ` <br />Signalur <br />Month Do y Year <br />P <br />�— <br />r <br />'5i a <br />R18. <br />Transporter 2 Acknowled ement of Receipt of Materials <br />T <br />E <br />Printed/Typed Name <br />Sign re <br />Month Day Year <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />L <br />1 <br />20. facility Owner or Operator Certification of receipt of hazardous, materials covered by -this manifest except as noted in Item 19. <br />T <br />Y <br />Printed/Typed Name ++ Signature <br />-L� <br />Month Day Year <br />®�" a-rl Qo (lC ter- <br />o I I ( I j?] a s <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) While. TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS, <br />EPA 8700-22 _ _ _ _ _ To, P.O. Box 3000, Sacramento, CA 95812 <br />