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7. Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.G emtor ID Number 2.Page 1 of 3.Emergency Response Phone Manifest Tracking Number WASTE MANIFEST 0=Zy�Z�" 1 1-800-424-93007002390240 JJK 5.Generators Name and Mailing Address Generatoes Site Address(if different than mailing address) r4fGener�tofs Phone: jr 6.Transporter 1 Company Name U.S.EPA ID Number Evergreen Environmental Services CAD982413262 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Evergreen Oil, Inc. 6880 Smith Ave. Newark,CA 94560 Facility's Phone: 510-795-4400 CAD980887418 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Patting Group(if any)) No. Type Quantity Wt.Nol. r]C 0 Zvi Z 2. W f� 3. 4. 14.Special Handling Instructions andAdditional Information � �s/7 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledtplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Ge tor'slOfferoesPnnted7Typed amen Signatu Month Day Year r:c- vr '�� oq 16.International Shipments P-- ❑Import to U.S. ❑Export from U.S. Port of entrylexit Z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials 111, Ar Cr Transporter 1 Pn yped Name Signature Month Yeaz a IY QTrans er 2 PrinteWTped N me Si ature Month Day Year F- 18.Discrepancy 18a.Discrepancy Indication Space ❑ �-y Quantity lL4 Type ❑Residue ❑Partial Re,edion Full Rejection WAS` &-Rez 0 -e-0 A-S �S7c Ft�M�v4A6� l—rq••rGs�-a f, 3 uit//997,Z7 �<i�rcn��+s,Csrsc/k� / Li ,4 T T Manifest Reference Number. I 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U W Facility's Phone: W 1 Bc.Signature of Altemate Facility(or Generator) Month Day Year Q Z ZA 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) rn ot. / �/ 2. 3. 7 4. 20.Designated Facility O-/Ownner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pnnted7Typed Name Sgnature Month Day Year EPA Forth 8700.22(Rev.3-05) Previous 6ditJons are obsolete. NATED FACILITY TO DESTINATION STATE(IF REQUIRED) ; 10487-1836