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<br /> Form Apprond Omit N9.2050-0039(Fapnes 9"]096) SCO Instructions on back Of P090 6. DapanmeM of Yoxls$ubfronm,Co s of
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<br /> 1. Geoerw.,'i US EPA ID No, Manlfenl Document No. 1 Pelle 1 the d oded a,nn,
<br /> I UNIFORM HAZARDOUS j,not oval oc by Feder l In
<br /> . ' WASTE.:MANIFEST'.
<br /> 3. Gx .rotor's Name aid Ma tmAddreit 7q Z ,,{{.. K �tpt"M Mb!'If0 f bdc9 .M Ydvmbaf k r r,
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<br /> Oro EVERGREEN ENVIRONMENTAL SERVICES
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<br /> � 9. Oe,ignaed Facility Name and Site Addrms 10 US EPA ID Number I
<br /> M 31 EVERGREEN ENVIRONMENTAL SERVICES � � LU
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<br /> LO 1Z 11. US DOT Dewription(including ng Proper 5h pp g ame,Na and Glo}s,and ID Number) N TTP. O nhiy U-11 ol f
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<br /> 3� G FNON-RCRAHAZARDOUSWASTE,LIQUID
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<br /> 15 Sae I Handling Imn cno and Additional 1 fo motion /
<br /> z 2 Hour Emergency Response Telephone No.:CNEP1ffREG 1-800-424-9300 Invoice r#(p
<br /> DOT ERG 171 WEAR PROTECTIVE EGUIPMCNT Sales Order 9(oZ i I`filoL/
<br /> -� 16. GENERATOR'S CERTIFICATION: I hereby doth,.that the lonomh of*11 larmiloment are fully and o- o, b demdb d fw by prop., hi,.im,name no da>s f ed c
<br /> fl Q packed,marled,and labeled,and ore in all r.,ecn in proper comdirion far hoopoe by highway aomdmg N appl lcabl lata,.fi. al and national Bovommmt reguiol ons ,)
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<br /> If I am a B quarmty gerwatoq I terrify that how a progrcm In plan to rodv a the volume and tai u,y of wain, g mond to Me degree,iP h d n mod m ,e
<br /> aromomrc IH p acRcable and!lar I have selected the praficoble method of treatment storage,or di spowl c�rrentlyo I lel 'b m. y h x,o M p tit and furore I
<br /> ]N them t human health d the eevi ormnMt OR,B 1 am a s..If lou nMy generator, I have made a goad faith effort to mmimiro my waxro gen<ran and select the he
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<br /> 0 Primed/Typed Name Fswami �C r �, Momh Day
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<br /> 7 w R -Momh Day,
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<br /> w 0 118 non, Ire,2 Arkmo ledgemr+ht of Rx lot Mderial
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<br /> h T Grinned/Typed Name I SgnaNre : Momh ,DayT
<br /> DO NOT WRITE BELOW THIS LINE.
<br /> BI a GENERATOR SENDS THIS COPY TO DTSC Wq7hla JCC YS
<br /> OTSC R 2A (1/95i To PG. Box 400 Sacramento, CA 95814046
<br /> :EPA 8700-22 y1 h r A t f � i
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<br /> 03/17/1998 "ORIGINAL MANIFEST COPY"
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