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<br /> .C.1himimo—Erviremememol Protection Agency
<br /> Form Approved OMB No.205 39(Expires 9 3094y See Instructions on back of.page 6. Do,.rp enl of Toxic Sabslanms Camr.,
<br /> Please print or type.:.Form designed for use on velar,(IYpirch)hpewries,. : -Baaainemn,Cal fano i
<br /> _. UNIFORM HAZARDOUS q'p PA ID No Manifest Do t No.- 2 Paga 1 I I mat on n the F d d
<br /> C/ I 1 1s r eq i ad by F do I la..
<br /> WASTE MANIFEST t
<br /> 3 gene to N e and Ma ng Address /� s A Sint, Madteel DuumeM NumbOH(�� q tr e
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<br /> p 5: Transporter 1 Company Name D. 5 pA 10 Number C State Lan porter Ib . A
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<br /> CP EVERGREEN ENVIRONMENTAL SERVICES
<br /> _ IC IA ID 19 18' 0 16 19 15 7 16 11 D Trop porta/e Phom..4 et}(5S0)795-44Gp t-.,
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<br /> fv Z 9. Deilgnared Fodllty N me and Site Address 10 US EPA ID Number G SIW,e:Faclls(�i ai eA{ a;p$p*xka u "s P 1?
<br /> C" EVERGREEN OIL, INC. N ,, CAD 9 '$ QtlB 8 7r 4 1 8 p{w
<br /> 6880 Smith Avenue " F«fim' )(510)P S, 400`y
<br /> v Q Newark, CA 94560 IC 'A D 19 18 10 18 18 17 141
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<br /> 11. US DOT Description(including Proper Shipping Name,Hozard Class,and Number)
<br /> Z _ No I Type Ouan(my WI/Vol 11 Waste NU .bet Tz1
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<br /> of NON-RCRA HAZARDOUS WASTE, LIQUID 0 0 1 T i T 1 (� G eaAGGM Ne
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<br /> 1-800 1�s 9390
<br /> = DOT ERG 31 ! WEAR PROTECTIVE EQUIPMENT
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<br /> re 1 ENERATOR'S CERTIFICATION I hereby decla a that the r.mrims of Me coni,omen are Ivlly and pc r ly described bay,by ,,.,a, h pp' g nam it ore class 1 ed,
<br /> Q packed marked,and labeled,and are in all respects in proper..edition for Vaospon by highway accord g t appl<abl federal,stare and me,nctian.1s.
<br /> If I a a large quantity nif
<br /> y gene.ator, I cey ho-at I hoo program in place to reduce she .olume and+mitt,, of waste generated to the degree I ha.e determined to be..
<br /> J econom pally Practicable and that I h -;cc,ed the F—h—ble method of bearmenp storage,or df;,osol currently ay-lable so me wh h murmacs]he present o+d bt m
<br /> o_ threat to human health and Me em r U OR if I ora a small qaa fn generator I hare.made a g d fa th effort to my waste general d seloo rhe best
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<br /> waste nionagemernemethod th t is oy.f.ble a me and that I_n afford 9 ,
<br /> 'Q Printed/TypedName SgnaNm. ,r>� Day
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<br /> �, o 18. Trans cner 2 Acknow daemenr of Rece pr of Mare,'ak
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<br /> EPA 87001^� ... .. .: _.:.. .., ..
<br /> J 3/16/1998 "OKIGI"IA L, MANSEE 3'I CG'F'V"
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