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Stab of Colifomla—Emmetur eb Protecllos Agency <br /> Form Approved OMB No.2030-0039(Expires 930.96) See Instructions an back of ptlg., 6. Deportment of Toxic 3ubnaues Control <br /> Piwm prim or ype..',fo d+ipned ler oae of aline 117p r hJ ypewiiler. ` S r m No Cal Iver o <br /> UNIFORM HAZNRDOUS 1. Geiator s mUS CPA ID No Manifest Document Na 2 Pape 1 lna,matior, a the traded ser as <br /> �Af rat required by Federal taw <br /> WASTE MANIFEST1922Y-912`15 �f <br /> l U q IZ j.3�` ' <br /> 3 r s NoTne'ond Mailing AAddrass SftLM`MaNYetl`Odcr+mMY I`IVstt1]BY+y" fr n V„ r f " <br /> O hr Y E <br /> Phom <br /> PEI A CGmbx s Mvf 4 ➢ y - " <br /> ro , <br /> Trans,inne,I Company Name 6 US EPA ID Number <br /> c? EVERGREEN ENVIRONMENTAL SERVICES m <br /> CAD 9 8 2 4 1 3 21612 MOM <br /> Q7. Transporter 2 Company Name 8. US EPA ID Number <br /> 9r Nofinaned Facility Name and Sib Address 10. US EPA 10 Number <br /> Zo EVERGREEN ENVIRONMENTAL SERVICES J <br /> -n s , <br /> U 12 Comainars 13. Total 14. Unit q <br /> Z 11. US DOT Desorption(including Proper Shipping Name, Hazard Class/.and ID Number) Quart Wt/Vol 11 � 's z <br /> W � <br /> N E NON-RCRA HAZARDOUS ASTE,LIQUID 0 10 1 T {Emy ' <br /> 0 C <br /> A I <br /> A. <br /> T <br /> R 38 <br /> . . <br /> W 1 5 <br /> Z <br /> V EPAf OIM <br /> W iF . <br /> 2 '�yi$bA�djdr ti$ad Abo4p( s-i E t EYl � a / r i aT/r ° n4 CAdn;fhk kLaedaf, riM Ati�w` an <br /> ry`.ws- .�' 49o- Nat:kr bytx�F}� .e Sic' <br /> J � •__ v <br /> Q 15. Special Handling Instructions and Additional Information '! <br /> a 24 Hour Emergcncy Response Telephone No.:CHEMTREC 1-800-424-9300 Invoice 5-77ILk;, <br /> Z DOT ER04tt 7J WEAR PROTECTIVE EQUIPMENT <br /> x <br /> I& GENERATOR'S CERTIFICATION: 1 hereby declare that the comments of this 9 ent ore fully and accarmcly described above by pir.,c,shipping nome and are classified. <br /> a packed marked,and labeled,and are in a1I respecn in proper condition for transport by highway according to applicable'mernobmnal and national gorammam regulmian. <br /> V If t am o large gaoamy generaroq 1 certify than 1 have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be <br /> economi practicable and than I have selected the practicable method of treatment,pinrc,c,.or disposal currently available to me which minimizes the present and future <br /> N ma°t1.human he Its and the environment;OR,d I a small gvanhy generator, I have mode a good faith effort to n.mie my to ge ercmi and u1e<t Him,Him,best <br /> m I w sro ma m <br /> na eend method duaa l available to me.and that I can afford - <br /> P li g <br /> ed/T d Name' Sn°Nre Martin, Day Year <br /> X 111 1a-142) / p iJ L <br /> Z T led em of Re : t of Mu en h <br /> A Pnnrod/T ped Na e ! Signorso- Month Day Year <br /> B r �IZI (UIL2I <br /> W , <br /> tFss 0 18 ns orter 2 AcknowYed emend of_Re<¢pl of Marerials <br /> II Pnnrod/Typed Name Si aNr/ I: Month Day Y <br /> LL01I <br /> 0 I <br /> Drepamy Indlcmion Space —�----- _ --� — <br /> a <br /> V F <br /> I, A <br /> L — t - _-- — — --- <br /> 2 F 0+. r or ooe t e d co'o_ f pt of n d o m to' Is co dot fern e.cept noted in_ur 39 <br /> T Pnnted/type Nome _ SignaN a Month Do-, lea, <br /> Y <br /> � 5 � v,s <br /> DO NOT.W y BELOW TRIS LINE. <br /> Who... TSOF SENDS THIS COPY TO DISC it:' SD w" <br /> DISC SMA I1/95), 'n. .- P.O.IM. .COOenio; CA 9SS: - <br /> me <br /> _ EPA WUO-11' '. <br /> ., 1T1 J t .-_cI ' <br />