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Sep 1:9 08 09: 05a STKN MRZDR LIN/MERC KIR 2094772084 p. 4 <br /> Please Print or type.(Form designed for use on elite(12-Pilch)typewMer.) Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Gen n ID Number 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Number <br /> WASTE MANIFEST L0a017S'1Zl 1 002390031 JJK <br /> 5.Generators Name and MaRing Add Generators SileAddress(if different than mailing address) <br /> �7 <br /> e.Transporter 1 Comparry Name U.S.EPA ID Number <br /> Evergreen Environmental Services CAD982413262 <br /> 7.Transporter 2 Company Name U.S.EPAID Numeer <br /> 8.Designated Facility Now end Site Address U.S.FPA ID Number <br /> Evergreen Oil, Inc. <br /> 6880 Smith Ave. <br /> Newark,CA 94560 <br /> Facililys Phone: Sin-74.5-4400 (-.Ann%tnQR AIR <br /> ge 9b.U.S.DOT Description(including Proper Shipping Name,Hand Cl ID Number, I0.Carter11.Tow 12.Unit 13,Waste Codes <br /> HM and PechngG�p(dany)) No. Type Quantity Wt"' <br /> Z 2. <br /> w <br /> 3. <br /> 4. <br /> 14,Special Handling Instructions and Additional Information <br /> 15. GENERATOWSIOFFEROWS CERTIFICATION:I hereby declare that the contents of this cmmignment are fully and amatey described above by the proper shipping name,aid are classified.packaged, <br /> marked and labeled/placorded,and are in all respects in proper condition For transport according to applicable ire a almost govemmemat regulalmns.If expert shipment and I am the Primary <br /> Exporter <br /> l candy Ne contents of this consignmentermfort to Me terms of Me attached FFAAcknowed [or Consecandy M <br /> I omiy that the waste minimization statement identified in 40 CFR 26227(x)(IFI am a hinge quantity gen a(b)Of am a indl q ealur)ip true. <br /> ter,mvemrs Prin, Name 5 nahpe Month Day Year <br /> I fc,A <br /> R <br /> J I8.Wearatiorral STipments <br /> T— <br /> El import to U.S. E]Export from U.S. Podorentril <br /> ? Tansportersignaere(for exports orgy): Dale leaving U.S.: <br /> IT Trampalarklussrletlgmmt of Rete ptof Materials <br /> saRZ N <br /> Wm Mon Da/ Year <br /> Transporter 1 PnntedSigns <br /> Tansxu2 <br /> dm <br /> a m <br /> Month Day Year <br /> f- <br /> 18.Discrepancy <br /> Its.Discrepancy Indication Space 0 Ouarmy, ❑Type ❑Residue ❑Partial Rejection ❑Fr9 Rejector <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(a Game" U.S.EPA IO Number <br /> J <br /> V <br /> LL FedMys Phone: <br /> W His.Skpakee of Alternate Facility(.,Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Mal Coda fi.e.,codes rnhazardous waste weakness.disposal,and reuyrJng evasions) <br /> 1. 1. J. 9. <br /> 1 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item fee <br /> PdnledTyped Name Signior Monts Day Your <br /> EPA Form 8700-22(Rev.3-051 Previous editions are obsolete. nrnrn x,arrr, ra nu ,nrn r+vnTr�ratrnu crux nc nrnnrnrrxx <br />