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NOV—�5— 00 14.0-- GREEN OIL INC 1:4 0 6 10 01R3 P.04 <br /> reset era.,,... <br /> 1 a-rype eoerafar'+US EPA ID No`' Mgdi6si Datums 2. Page 1 Informatiqn in the shaded arras <br /> UNIFORM HAZARDOUS if not required by Federol 6- <br /> WASTE MANIFEST �- ab <br /> Noma and Mailing Address A. Slolt Mani Fest Document Number <br /> It 21757452 <br /> /� � SToGlC/G*• 5%, S pC-I r B. Slot.Ganerotar's10 <br /> Na C'nrralor's Phan+I } f. — 5'O <br /> §. Transporter I Compony.Nome - 0. VS EPA ID Number C. State TransPorter's ID[Reserve .� <br /> o EVERGRI"EH ENVIRONMENTAL SERVICES 10-LA $ 2 1 2 $ 2 fl. Tronspor{ex's Phone 800 872.5284 <br /> d <br /> all ]. Traniporw 2 Company Name 8. US EPA ID Nyrn6r E, Slat*Transparler's Ib(Reserved.[ <br /> F. Trgnsparler's Phan. <br /> 9, Designated facility Name and Site Address 10. US EPA tp Number G_ Shale FotiDy's ID <br /> EVERGREEN OIL,INC. 8 17 14 11 IS <br /> 6880 Smith Avenue H. Facility's Phone <br /> -��- Nei[0k A B Z 51 Q 79$4400 <br /> 12, Cantoiners 13. Total I;. U.il <br /> I t. US bOT I7eariptian Binrlud;ng Drape*Shipping Nome,Hazard Clear,End ID Numb.rl No T e C.faanlity Wt/Val 1. Wasle Number <br /> a OJ�Z EtdF-!" State <br /> NON-RCRA HAZA DUS WASTE,LIQUID 0 0 0 7 G EPA/drher <br /> Nb. '�" Slate <br /> 40aul E <br /> -4 A EPA/Other <br /> T c. T State <br /> Q EPA/Olher <br /> i d Sro14 <br /> z�1 <br /> � EPA/Other <br /> r Z J, Additional bnscriptioni for Materials listed Above K. HondlinQ C s Far Wastes listed Above <br /> w <br /> t. d, <br /> a <br /> f 15. Spacial Handling instruslions and Additional Information <br /> a 24 Hour Emergency Response Telephone Nor-GHEMTREC 1-800-424-9300 Invoice l 9 J-6/1 <br /> zLU DOT ERG 171 WEAR PROTECTIVE EQUIPMENT Sales Order t doac,4 ' <br /> 16. GENEIEATors CERTIFICATION! C hereby declare that the contenls of this aonv9 ens ore Fully and occurotely descnbrd gborn by proper shipp ing name and a clns►i ed,packed, <br /> mpArd,andslobefed,and ore in all respells in proper condition Ear tronsparr by highway according to applico61a international ord natigna(government rvqulalions. <br /> J < <br /> _ IF f am o forge qudnliglnerglgr,I certify ihnt l have a Pieram in plea to reduce rhe volume and raxiciiy of.rade genarapd ro the degree!ka.e derrrmined ro be eeatwmicdly <br /> +� prodlaable and that i hcva selected the Practicallia mnohad of trralmrnr,�1gro13 hr d 1paiie currently a+ails Ie W me which minimizes Ike present and Fulura Ihreat Io human heohh <br /> and rite envirc;nmenl;OR,IB I am a imglf quantity generator•I have made a good Faith effao In minirmizo my wale gaeerahan and elect the best urosie management method Ifiar is <br /> available to me and shat I can afford_ <br /> } Prin 7 rd Name SiAnehJre mp.1k Day Year <br /> v 2— <br /> tAJ m N 17. Traeste 4 Aclr+awled ear 4f Receipt of Matoriuls <br /> Uj 1, Printed/Typep Noma Signalwr Month Day Year <br /> LN <br /> cLsa 6 * Q$�ad' 'r <br /> LL. a 18. Transporter 2 Acknuwled amen)gi Recti sof Materials <br /> 4 T Printed/Typal Noma Sigdaluft Manrh Day Year <br /> s►1 E c <br /> t 1 i P, Disurpaney lndkotian Spar. <br /> z F - <br /> A <br /> L <br /> I 20. Facility Owner or Q erolor C40ificarian of racei 1 of hazardous mated I coveml bx this manifelf wept as noted in Item 19 <br /> T Pr" ane Sign Month Day Yea, <br /> DO NOT WRITE BELOW THIS LIME. f <br /> OTSC 9023p�1F/99F wkile 750F SENDS THIS COPY TO DISC WITHIN 30 DAYS. <br /> EPA 98022A To P.O. Boa 3()00, Sgc,amertto, CA 95812 <br />