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,Aar IC llornlo-fnwon�erenl Ro xeon Ayeny <br /> fiS10 IftlFUCIDtls Orback 01 hags b. rp<almenof r S 4onfo1 <br /> Far AFP owd ONE)No 2050.0039(Expires 930 96) S«rwnx1.,Gol"Ifed <br /> Phrase Firor type Form drooned/nr we eeln(12,0,4)lp,sv,le., <br /> I Gmmrabr s US EPA ID No Moniletl 0 oew l No. 1. Pogo I Inlormolbe In the shaded areas <br /> UNIFORM HAZARDOUS 1 I+mol required by Federal law. <br /> WASTE MANIFEST "�Lyi rJ� �}- <br /> 3 Gen^r fors No tie and M I J/ Address - A Stale Mar IfeO Dammer Ni, b r <br /> 95334576 <br /> B State Gorwrator s ID, <br /> 4 GomramrS Phone �lllt✓�/x, L':0 � 1 1 1 1 1 1 <br /> j 5. Transporter I Company Name 6, US EPA ID Nomber Cy State Twntponer's 10 <br /> ° EVERGREEN ENVIRONMENTAL SERVICES C1AID1918 10 1619 15171611 ° Tranepo„e;+Phone (5110)795-4400 <br /> Q2, Transporter 2 Company Name 0. US EPA ID Number E. Stale Transporter i ID <br /> U F. Transferrers Phone. <br /> TQ <br /> Z 9, Designated Facility Name and Slur Address 10, US EPA ID Nomber. G.Slate Facility's ID <br /> in a EVERGREEN OIL, INC. CAD 19 18 10 18 18 17 14 j 1181. <br /> p 6880 Smith Avenue H. Fcidliy'Phone (510)795-4400 <br /> f < Newark. CA 945601 CAD 19 18 10 181817 4 1 8 <br /> V <br /> } . d 10 NvmbQ No Comoinien e 13. Total 14 Un,t <br /> Z ILUS DOT Deuri ibis 'r<Ivdi MPro Proper Shipping Nanta,Mezerd Class,an <br /> Ouanti WI/Vol I. Worse Nomlaer <br /> 2 Stuh <br /> r <br /> LZ <br /> _ a Vj � 116, W'/'7/ "� EPA/other <br /> o f NON-RCRA HAZARDOUS WASTE, LIQUID 0 011 T 'T J G NONE <br /> m N b. SbM <br /> d R EPA/Other.. <br /> sn R <br /> .. EPA/CRher <br /> w <br /> Z Sm e <br /> V EPA/Omer <br /> w <br /> N <br /> Z J. Addis 1 Descriptions for Matermis listed Above N. maim,Codes for Woatm listed Abeve <br /> is <br /> Is. <br /> N <br /> W <br /> c. <br /> d. <br /> a <br /> I S 5 Mandiin Insav<rons and AddTronol Inlormaf on <br /> a IPJ EMERGENCY <br /> Z CALL CHEMTREC <br /> w 1-800-424.9300 <br /> OOT ERG 31, WEAR PROTECTIVE EQUIPMENT <br /> 16, GENERATOR'S CERTIFICATION.1 hereby declare*0 the conrents of this consignment are fully and acevrately deuribed above by proper shipping rwme and ere classified, <br /> < pocked,marked,and labeled,and are in all r.,cn m proper condman for transport by highway according to applicable International and national government regvlafions. <br /> U <br /> If I am a large quantity generator, I<endy mat I have a program in place to.edvice me volume and toxicity of waste generated ro the degree I hove delermred to be <br /> a eronomically practicable and that I have sekceed the Predicable methodof treatment,storage,or dispowl ,s rnmilly available to me which m'nimizes the present end fvNre <br /> 'O threw to human health and he environment;OR, if I am a small q.Pfty generaror, I have made a Read loch effect to minimize my wastegenaro6e.and select the best <br /> w waste management methal the is available to me and that I can afford. <br /> O P rated/Typ d Name - Sip - r enth Day Year <br /> Z <br /> N IJ Tran rt I A k owl dgemenr of Re Pr of Marclo�- <br /> 17 A P'nted/T ped Name Sign Month Day - Yea <br /> C N O <br /> P <br /> w O18_Uon ponx 2 AcknowiedaemeM of Re upr of Materials __ <br /> RP coed/Typ d Name <br /> Si MonthDay Year <br /> O r 1 <br /> w <br /> N 19. Diu repo.,Indcasom 5,o<, <br /> < Fl <br /> U A - <br /> Z C <br /> t <br /> I 20 F-1-, C- Vy C10-1 o I 2 al Fd —1—bl rp red by, 1 -Ird n l em I9 _ <br /> Pl/me Sig N Mom+ '2Day Y <br /> DO NOT I ELOW THIS LINE. - <br /> 'Irl` .0 r fv CST C 'r. <br /> DISC 8022A 19x941 -u P.O. Lir ; mann , , CA 95&Ig - <br /> EPA 87W-22 <br /> ,r 'J3i17 /1998 "OR IG 'ITAL MAN IFE: S COPY " <br />