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Srae of Cal lom�a—fndronmm!al Praxtion A9<r,ry. <br /> Form Approved OMB No.40500039(Expires 930-94) -- io See In seductions on back of page 6. orrmem of is.:x Control <br /> sabrma<m <br /> Please pnm or.type. Form desiprtM/or ose on elite(17pikh)rypewrvror. DepSacromork California <br /> UNIFORM HAZARDOUS 1. Cen S,,.r't US EFA ID W. Manifest Docvmenl No. 4: Page l Information in Mo shodod areas <br /> WASTE MANIFEST s- D 1 ural riga rad by FedoraI w <br /> L %. of : <br /> 3. Genermor's Name and Mailing Address //06 <br /> h4. Genaraoi s Phone <br /> co <br /> ri 5. Transporter Campony Name 6:'.,US EPA ID Number <br /> m EVERGREEN ENVIRONMENTAL SERVICES <br /> C;A D 91810161 9 5 7 6 1 <br /> Q7. Transporter 2 Company Name s US EPA ID Namber <br /> OV <br /> Z9. Designated Facility Nome and Site Address 10 US EPA ID Number <br /> CV EVERGREEN OIL, INC. <br /> 6880 Smith Avenue <br /> M U Newark, CA 94560 CIA ID 9 8 0 8 8 7 4 1 8 <br /> Z 1 T US DOT Deuriprion(Indading Proper Shlppmg Name,Ha.rd Cl.,,and ID Nam6er)' I2. Comainers 13. Total 14:Unit <br /> = No, -T Ouanr WyVoI' <br /> C'1E NON-RCRA HAZARDOUS WASTE,LIQUID 0 0 1 T T 8' G <br /> ro' N b. . <br /> m E <br /> R <br /> < ! � <br /> d A <br /> o T <br /> m D <br /> R <br /> Z <br /> Z <br /> aa <br /> Z <br /> �� <br /> a <br /> N <br /> w <br /> Q <br /> Z <br /> 0 15.:Special Hardin Imebachans and Addrional Information - <br /> r r- RJ EMERGENCY <br /> Z CALL CHEMTREC <br /> aa 1-800-424-9300 <br /> _DOT ERG 31 WEAR PROTECTIVE EQUIPMENT <br /> 16. GENERATOR'S CERTIFK.ATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and era dassiliea,. <br /> Qpacked,marked,and labeled,and are in all n specfs m proper condition for rronspod by highway according to applicable federal,state and international laws. <br /> 'e ms If I am la ge gaam ty geoarator,I.certify Mat I have p,.,nzmn <br /> in place to reduce that volarne,and t y of te enc,.Id to the d g I ha date ed m be <br /> ecorar ly practicable and that I have selected the frodiccithod of trommem,s r rage disposalcurrently available r e which < Me present d hurt <br /> F' -y Mrem to barren health and the en..ro me t, OR,if 1 am o small .fly generator,I have made a go d foth eflort to m datxe my.waste generation and select the best <br /> cK <br /> {, waste mono emem method Ma a mailable to mo and Mar I can alford l <br /> 0 Pr' ted/Typed Nam< . Signomre Month Day Year <br /> >' / C <br /> V <br /> Z * 17. Transporter 1 Ackiwwkd arrant of Receipt of Materials I <br /> w P6 Typed Nome y� SignaNro l Momh Day I Year <br /> oI8..Tram 4 Acknowled ement of Rept of Materials / 1 <br /> �i <br /> Printed/Typed Nom< Sigtwtare ManM Day Ye r ; <br /> '=o, 4 <br /> V 19, Discrepancy Indicmion Space <br /> V�.A <br /> Z� 1 <br /> ( 20 F.cd, Ow or Oper C s f,a,pu.d ere r,r of h_a does mater al covered b lest n_pr as r-IonT em 14 I r <br /> T PrnhA/iyp one i N\1\ X77 S:gr:aNre "� / ,N nM poly <br /> ���� DO NOL.;WRITE.,,B OW THIS UNE. <br /> � (, ,IS COPY TO PIS', r w' t(1 DAYS <br /> OTSC 8022A (7/97 (,4 ' •• .. V r� l �..✓,=m N..9 �:$r ( i! �"C'-_ . .Ta6. YP O. dole Kfome t9v <br /> EPA 87077' <br /> 03/16/1998 "ORIGINAL MANIFEST COPY" <br />