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NOV-15-2004 14:W F��rr U l L i l li_� 1 LI e.08 N-0.5 <br /> l!Form Approved f.Wb No.":-V-UUSY ftxparei Y•JU-jr.) .aoa rrratr�crr�ara err vµ�o,�u[ Deportment of Toxic Substgngyf Canlrol <br /> ✓'/ <br /> Pleat*print or typo. form designed far use ua#144 02-pi r Sdcromento,California <br /> UNIFORM HAZARDOUS nergrar's US EPA Iia No. Manifto Document 2. Pogo 1 Informumm in the sbod■d areas <br /> WASTE MANIFEST i]not r°fequired by Federal law. <br /> rs 9 0 7 . EES4 <br /> 3. Generator's Na a and Mailing Address iA. 51a1e Manifest'Oacumrmr Nurnbt 0 <br /> c�c +�9 200 is= G.e,tr*laers IP , <br /> h 4, {renarator's Phone <br /> -CA ] ''c,�= <br /> iY 5:TransporNr'I Company Name 6. US EPA Ifl Number G <br /> EVERGREEN ENVIRONMENTAL SERVICES ] R 18 ' vh �� �7� <br /> 7. Transporror 2 Campony Name 8, US EPA ID Number E!$Iola �sni' tri lD ■ <br /> -t Fa1pe1°fi , <br /> s-;r s. - <br /> V 9. Designated Facility Nptno and Sirs Address 10, VS FPA 117 Number {t IA <br /> ktip q t <br /> 30" EVERGREEN OIL,INC. t:rt , ? <br /> n# 6880 Smith Avenue <br /> Newark,CA 94560 ic A D 1913 10 18 18 17 14 11 18 <br /> 1 I. US DOT Description limAyding Proper Shipping Name,Hnzerd Oats,and IP Number) 2. Confoinors 13. Total 1 A. Und <br /> No. Type Quantity Wt/vol 1., as Mumfoer <br /> z a otj+wc*{#-r <br /> NON•RCRAHAZAR!'HAZARDOUS LIOIfID <br /> G 0 '! T T ojogjW G 0(I� <br /> N b. ta , <br /> co E E►7/oliror t <br /> v A <br /> U <br /> R <br /> i ;.. <br /> � �'N1►'EOt6w' <br /> ut , <br /> 'rt J Addufamal D�ewlpttoni for Materials ltFladAGav! , K..tfoodl ng Codex Far Wastes stud Above <br /> Q <br /> j <br /> U.1rz <br /> 4 <br /> O15- Special Handling Instruiit;ans and Additional IJoemation <br /> 24 Hour Emergency Response Telephone No.:CHEMTREC 1-800.424,9300 Invoice I)i--5-7�I z <br /> DOT ER6171 i WEAR PROTECTIVE EQUIPMENT sales Order# 96 7 060& <br /> LU 1 <br /> r- <br /> 16. GiNERATOR'S CERTIFICATION. t hetaby declare that oho contents of tltiiS carts nmenl are fully and occurwelyy desceibad a6nve by prnpeF ihippiAg name and aro clossifitd,packed, <br /> umarked,and lobolod,and aro in o1I resIt in proper condifion for transpon�y highway according b applitobie internnlienal and national govorrimont regulations. <br /> If(am a largo quanuy rjanerator,I certify that I have a pm lam in plow to reduce the volume and toxicity of waste genorcrtd to the degree I have determined to be tieonomicolly <br /> EL practica6lc and Thai I Nova selected!ht IC,totticablt method of treatment,storage, or disposal currently avallghlo to me which minimires the preEent and Iuture Ihreaf so knmon heohh <br /> V) andthe anArenMenl;OR, If I am a smair quantity penernsar,I Itavo nodo a good faith a minimize my wails generation and select The Lost wusla management method iltat it <br /> W I available to me and that f son afford. <br /> QPrinted/Ty rd Yoms Sipnalvr� Menth Dny Yeer <br /> T <br /> 17.-1105"Alpaiter I Acknowled amen}o Rocei pi of MoFeriols <br /> s rrinf ed N e 5ignalvro Month Day Year <br /> s" 1Lf/L//tXC'1 jLU <br /> am' C <br /> r <br /> LL- e 10. Transporter 2Acknowla4stommil pf Rocwi r of M¢lerials <br /> Q T Printed/Typed Name <br /> 5ignmure Manrh gay Year <br /> a w E <br /> V 19. Discmtrcncy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> E <br /> I 20. Facility,Ownnr or Op—tor Certs olion of rotes r.16....do..malar:oft covered 6y this maai6d XC615t of noted in Ile, 19, <br /> T' Printed/Typed Name _{� I +month pay y�Year <br /> DO NOT WRITE BELOW THIS LINE, <br /> Whifc, TSOF SENDS THIS COPY TO DT5C WITHIN 30 DAYS, <br /> DTSC Pl022A 11149) To: P.D Box 3004, Socramansa, CA 95412 <br /> EPA 8700-22 <br /> TOTAL P.05 <br />