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<br /> "Form Approved OMB No 2050.0039(Expves 930.94) See Instructions on back of page 6. Deporrmmf o1 T s 6 mean Connor
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<br /> 1. Ganeraroi s US EPA 10 No. Manifest Document No. 2 Page 1 Ifo.wen in rha ihcd,d armor
<br /> UNIFORM HAZARDOUS ! 1 r c red by r d I I
<br /> WASTE. MANIFEST Q - 7 W G 9 f ^.
<br /> Ge rotors Name and Me ng Address State Moruf<{t Da vrwrd Number k
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<br /> h d Generator s Phone ( 3r L �# „p��4?Lf.. fy .�trq V ; f .1- g
<br /> :r O 5, Transporter 1 Company Name .r 6 US EPA ID NumberaA4 ”'
<br /> m EVERGREEN ENVIRONMENTAL SERVICES
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<br /> 7. Tors,orter 2 Company Name 8. US EPA 1D Number +Y U11
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<br /> �``—D Q 9 Design/ated Facility Name and She ci 10 US EPA ID Number y t wco Z y kld .Z,E'r het t -
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<br /> 19 EVERGREEN ENVIRONMENTAL SERVICES Q
<br /> 1 11 ,US DOT Description ludo Proper,Shipping Name,Hazard Class,and ID Number 2 C oto ne 3 i 4 U t
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<br /> Q IS Speciol Handl-ng Instructions and Additional lniormafon
<br /> IN EMERGENCY
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<br /> CALL CHEMTREC
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<br /> _ DOT ERG 31 WEAR PROTECTIVE EQUIPMENT --
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<br /> 16. GENERATOR'S CERTIFICATION: I hereby declare Man the center%of the c.no,rmcn,are hilly and accuraeely deeuibed obave by proper Epp g nam,,and are c ass i'ed.
<br /> packedmarked,and labeled,and mem all respects in prope,,ondmim for xansport by highway d.,to.,,k.bl,Earl acre and t r 1.a s
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<br /> II I am a large quantity generator, I certify that I have a program in place to reduce he volume and f ty of waste generated to the degree I have derorm ned m be
<br /> economically proaicable and that I have selected the practicable method of treatment storage,or disposal currently available to me which m nim zes the present and fuare i
<br /> w three,to human heahh and the environment; OR, if I am a small quienhty generator, I hove made a goad fart M effect td mnimre.my waste gencral and select the best
<br /> N 1 ste 9 t meth d M t' vail d
<br /> to me and that I an afford
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<br /> DO NOT.WPI B THIS LINE.
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<br /> 'DTSC.8022A 17/92);
<br /> EPA 8700-22 .
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