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{ 6rote of CalNomb—En.ironmenlol Protection Agency
<br /> Form Approved OMB W.206 39 E.pres 9-3P96) S@@ Instructions OG back of ptlB@ 6. DeponmS of s"' Substances Control
<br /> Please print or type Form designed for use,n efiN(12pnch)"wher,
<br /> - SIXramado,Ca8lorrea
<br /> UNIFORM HAZARDOUS 1, Cxrmraroi s US EPA ID No. Muni7esl DaumeM No: 2.Page 1 1,ms,required
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<br /> Is trot regmred by Federal law
<br /> WASTE MANIFEST o ,'j O 2%7 gZ I Cd G � _ of 1 EES4
<br /> 3:.: Generator',Namnd M.;Im0 Address 1Lpp11r , sT�DOcSr1TSLhzJ`/Z0 • AB.:f$fd�,W Affesl l•fD r°+ee'r
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<br /> nsporror 1 Company Name - 6. US EPA ID Number $ ` lt'WN,/ F o I31*; iii, 1
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<br /> m EVERGREEN ENVIRONMENTAL SERVICES
<br /> CAD98241 3262
<br /> Q 7. Tramporrer 2 Company Name 8.US EPA ID Number ate T ,I ru
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<br /> d., Z 9. Designated Fuceiy Name and Site Address 10. US EPA ID Number
<br /> ODp EVERGREEN OIL,INC.
<br /> M 6880 Smith Avenue '
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<br /> 11. US DOT D ntcri (including P Shipping Ndme;.Hazard Class,and ID Number) 1 12 G,IaaIMR 13. Total WI Un8 ,
<br /> � Z Wes^F a raper aping. No -T oaanPey wt/vol
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<br /> E NON-RCRA HAZARDOUS WASTE,LIQUID 01011 T T 3 O© G Pxu
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<br /> 0 15Spedal Hmrdiio,Instrvc4om and Additional Information
<br /> z 24 Hour Emergency Response Telephone No.:CHEMTREC 1-800-424.9300 Invoiced
<br /> w DOT ERG 31 WEAR PROTECTIVE EQUIPMENT
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<br /> 16. GENERATOR'S CERTIFICATION; I hereby declare that the contmh of this conignmenr ore fully and ac urmely described abowe by proper shipping name and are chis Ified,
<br /> Q packed,maned,and iebeled,and ore in all respects In paper candman for transport by highway accordir,To applicable ImemaEonnl and rwnwal gpeorrimen,re,ulm ons j
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<br /> If I am a large asamity generator,1 certify that I hove a program in place to reduce the volume and tonicity of waste generated to the degree I have determiiwd to be
<br /> yxarromkally practiable and that I haw,selected the practicable metfod of hemmenf,storage,or disposal currently.ovadable to me which minimizes the present and future
<br /> rte throat to human heath and them nn OR,N 1 ore o small q army,generator, I haw made a good font effort so minimizemy waste gene anon and sell t the best 5
<br /> on wom man m met method Moe is 'I ble to me and that I or,:nfo d //�J' /_/
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<br /> Z It 77. Tram r 7 Acknowled m of Recei of MoteraIs _
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<br /> W0 18. Tromponne,2 Ackrrowlod meet of Rece, t of An .—ale _
<br /> Pnmed/Ty,ed Name Sgrafv.e Monett Day year, :I
<br /> - N I 19, Oncepoocy Indication Span til
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<br /> Z Fail O.mNar or Op error Cerr.Gcon cf. viae of h r:nm mpnnals d M* miler e—,,a rated m Hem i9 _
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<br /> DO NOT WRITE BELOW THIS LINE. -
<br /> Wfrie TSDF SENDS 8115 COPY M DISC viiF N 30
<br /> DISC 8022A ;1/95) ,. ,. To _a.0. Boz 3000, Sncra recto, U 95812
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