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State of C I lo—E ammentnl P-a,stim,Agenry �.
<br /> Farm Approved OMS No 2050.00391 E.p rt+93094) See'Instructl0115 On back at I jqe 6. Departme.t of Toxic Substances Control
<br /> Please print or 1111. Farm designed for...on elite(12pdrh)typewriter, —Saoame,to„Colibmia
<br /> 1. Generators US EPA ID No. Manifest Document No. 2. Page I Information in thelh.d,d at.,
<br /> UNIFORM HAZARDOUS
<br /> isnot required by Fedor I law
<br /> WASTE_MANIFESTF} "0 U I D Z 16115- aj, 1 1 10 ' r i 1
<br /> 3 Gene ator's Nome and Mml ng Address 1A. s
<br /> //J r� �'t`a Es Aj.:$tale Man last Document Number
<br /> 2 5�410a7z�.
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<br /> md Generator s Phone aU-1 IE31 xw + `�F fn '
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<br /> 5, Transposer 1 Company Nome 6, U$EPA ID Number PaNt p
<br /> EVERGREEN ENVIRONMENTAL SERVICESa r�
<br /> GAD 980695 761 - ` 8� 7 " 28,,
<br /> 7. Transporter 2 Company Name 8. US EPA iD Number
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<br /> T-1 9..Desig coed fgEiliy,Name and Site Address 10 US EPA ID Number
<br /> �! EVERGREEN OIL, INC.
<br /> LL 6880 Smith Avenue '' - r S '•
<br /> N < Newark,CA 94560 C A D 9 8 0 8 8 7 4 1 i8 a
<br /> M U ' 12 Ca t iric,s 13- Total Id. Unt
<br /> Z r 1 I.'.US DOi Descrip(on(;.eluding:Proper Shipping Name,Hazard Cbv.and ID Number) No.. .,:T Qubntuy, - WtiVol
<br /> c a SOMBUST18tEte81D NA1270--- ✓� 1 `=
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<br /> E NON-RCRA HAZARDOUS WASTE LIQUID ' � f
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<br /> OI AnAddiliaol ipti0ris for Mnfefsati Abaw '-t; y, rH ` a -•'< p„y S'S ww.-rX .K+lJend)try Caile"szlor ostas 4"..' PFAtibv't-.
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<br /> 11. Special Handl, Instroo ons and Additional Information
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<br /> Wear Rubber Gloves 24 hour emergency response 510-795-4400 Emergency contact Kirk Hayward DOT Guides 127
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<br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accm.uiy described above by proper shipping name and are doss,bed,
<br /> Q packed,marked,and labeled, ding
<br /> bele ,and are in all..spaces in proper condition for tronsport by highway accorto applicable federal,state and imernatonow
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<br /> If,I am a large quemty generator, I Coity that I have a program in place to reduce the volume and toxicity of .+ante generated to the degree I have dearm-rd to be
<br /> lecon.mil.ly.prem,icatble ad that I base selextod the procti,a6le meth d of treatment,storage,or disposal u,ently coracd.ble to me ei mmmmose, he present and ii,tae
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<br /> threat t human h alth oil the env t OR if I am a small quantity generator, I have made a good faith effort to minimize my wase gon".1nom and select the best
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<br /> I _ rite management method tit 1 s av blx to me and that 1 can afford. T <
<br /> O Panted/Typed N $9noNr l A•, h Day:
<br /> rz�D 13Aan90Au�[ �a3
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<br /> T 17 'Trans on r 1 Acknowled t of Rece f of Materials I
<br /> Ci A ed/Typed.Name r� $g Nr% Month Day year
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<br /> o ' 18 Tran d 2 A k wl d e ant of¢ -v of Mmenols t/
<br /> w P P mu,d/Typed Name m $-g aNre Month Day veor
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<br /> w19. Discrepancy Ind2aton Space
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<br /> 1 20 Fac,lity Ovrner or Operator Certification f �f ti rdaus come d b th n fast eec�ed in It 19
<br /> T Prnted/Typed Name r \/�P-� Signature /� � 's Day
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<br /> DO NOT WRITE BELOW THIS LINE
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<br /> [)TSC 6022A 17/911
<br /> .EPA 87Cri 22 —
<br /> 03/16/1998 "ORIGINAL MANIFEST COPY"
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