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Time of CONfomio--EmmsommM Pftftn n Agency
<br /> form ApptevM OMIT No.20304039(Ezpim 9.7695) See Instructions on back of page 6, Dnvanmen of Task Substances Com,nl
<br /> Pkow Print or typ. .Form designed for use an euro(12pikh)ypewn in $"mrenso,C.100m,la
<br /> UNIFORM,HAZARDOUS f. OiOneraran us EPA ID No, Mandel D«ument Na`� 2. pogo 7 fait .,n; In rhe Fhoded arca,
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<br /> WASTE MANIFEST X (.1 J7/ �� 'IT�S �,Zlx °�
<br /> X33��er/g elor''Name and M64g Address A Store Manifael Domed N.entior
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<br /> 00 �-EVERGREEN ENVIRONMENTAL SERVICES
<br /> CAD9 $ 241 3 262Drmnpor%Pmr. y t
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<br /> M Z 9..Designated!Facility Name and Sire Address 10.,US EPA ID Number c�S�aM,f«IrAffa ID :+§ "f`r 21 °..,1 • f:
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<br /> 13. Special Handfirp Inatrvctia-ss end.Addilioml Inlarmalias
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<br /> DOT ERG 31 WEAR PROTECTIVE EQUIPMENT
<br /> Id. GENERATORS CERTIFICATION; I hereby declare Mat tho contents of this cons gement are fully add ac a N d nbed above by Prope sl,pprng name and am lassfied,
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<br /> If I am a large quantity gemraror, I certify Mm I hied;a program in place to reduce Me volume and trx'<ty of waste generated tr this degree 1 haFe determined to be
<br /> ecanom Ih procncoble and Mot I have se"d Me prackcoble method of frentmem sroroge,o-disposal currently add table to me wh ch minimiz.the present and lature
<br /> N thnort he human he.%and the enNronmanti OR,R 1 one a .If quay”gimrabr,I have made a good faith effort to mmim ze'my caste generahon and sale,,the best
<br /> "vast mm intent method Mot i,ovailabb Io me acid that Dean afford
<br /> 01 P.ntd/Typed Name _ SigriaNre
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<br /> YPenrod%iy Normo { t r5ig ailuro Murrill, Day
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<br /> DO NOT WRIT E WITHIS LINE.
<br /> Whir, TSCF SENDS THIS COPY TO DISC WITHIN 3C DAYS
<br /> DISC 8022A (1143 To: P.O. riser 3IKO, Sc r.rm,,M, CA 95817
<br /> EPA 870x-21
<br /> 03/17/1998 OR IGIN7 +�,..
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