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Tmrspar;c• FREMOUW ENVIRONNIflFTAL SERVICES -'-- INC Phone # 800-559-3274 I CAR000171017 ' : ;.olrpan F,anm —" U.t; EPA IC Number h Designateo �aclllly Name and Site Acotess EVERGREEN 01, INC. �,.S EPA ID Number 6880 SMFTH AVECAD980887418 NEWARK, CA 94560 Facility's Phone •510-795-4400 ya �andPacking(jrouv(iiany): .f.5 DOT Uescnowf I,rstuoing crape: Shipping Name. Hamm. class IG v.rrnbe' t; ontauiers HM 1 t Tota: 12 Unit 13. Waste Codes Nu Type Ouanlily WI.Nol (if Non-RCRA Hazardous Waste, Liquid (Oily Water/Sludge) D01 TT G 223 0 ~ i i a LU w z U-1 I 4 1 tylfewme' 14 Special Handling msf!uclrons and Additional Informauun HANDLERS TO BE QHR TRAINED AND W - „ h :ereratc Numor' Form Aporovec OME Raaf No 20515.0035 �� '''AN'�E'T yl., o..,., .,.. I, 4. Manifest Trac king Number conform to 1 I certify that the waste minimization statement identified in 40 CFR 2 CAL00027136a9 800 424-9300 CHEMTR 0 0 6 0 6 8 5 5 6 J J K r;ama and btawny Andress ;',orer,i;u ;idforew !nar• manin!. aooress —r PROINC. -6!y _ `" � JL`✓ Z — 7mnSUbr!e' 51911alure(lot exvon., orlly, elft'A!Xr• - – --- -- ----------.— W 050 EL M 9050 ELKMONT W�4Y :;ilii' 15453 N THORNTON ROAD 7ranspone 1 Pnn!edi ped Name Generators P -ion ELK GROVE, CA 85624 �Ignatule - Month Day Year LODI CA 95242 Transporter Printed Typed Name 1,51-1-111P? L Tiansporter ! :omoanv Nam" - — 1S Ech ID Number Tmrspar;c• FREMOUW ENVIRONNIflFTAL SERVICES -'-- INC Phone # 800-559-3274 I CAR000171017 ' : ;.olrpan F,anm —" U.t; EPA IC Number h Designateo �aclllly Name and Site Acotess EVERGREEN 01, INC. �,.S EPA ID Number 6880 SMFTH AVECAD980887418 NEWARK, CA 94560 Facility's Phone •510-795-4400 ya �andPacking(jrouv(iiany): .f.5 DOT Uescnowf I,rstuoing crape: Shipping Name. Hamm. class IG v.rrnbe' t; ontauiers HM 1 t Tota: 12 Unit 13. Waste Codes Nu Type Ouanlily WI.Nol (if Non-RCRA Hazardous Waste, Liquid (Oily Water/Sludge) D01 TT G 223 0 ~ i i a LU w z U-1 I 4 1 f ! 14 Special Handling msf!uclrons and Additional Informauun HANDLERS TO BE QHR TRAINED AND W PPE 9b1) RG # 171 Ine contents of this consignment are luliy and accurately oescrmeu 15 GENERATOR-Si"CERTIFICATION: I hereby oaclam mal marked and fabeledrplacarded, and are in all respects in proper condition Exporter, I certify that the contents of this consignment aoove by me proper snipping name, and are classified, packaged, for transport according to applicable International and national governmental regulations. If export shipment and I am the Primary conform to 1 I certify that the waste minimization statement identified in 40 CFR 2 terms of the attached EPA Acknowledgment of Consent 2.27(a) (if I am a large quantity generator) or (b) (if! am a small i General � eraf Pnnted ype ame quantity generator) Sig na ` Month Day Year (! —r 1E utlernr,llcna! hlpint nis _ `" � JL`✓ Z — 7mnSUbr!e' 51911alure(lot exvon., orlly, elft'A!Xr• - – --- -- ----------.— W 1? Transporter Acknowledynleni Or ftP.r.f'ipi of Ma!erlily :;ilii' 7ranspone 1 Pnn!edi ped Name 0 �Ignatule - Month Day Year ZZ Transporter Printed Typed Name 1,51-1-111P? Slgnafure Month Day Y r — 1f! Ulscruuanfa• — — --- 18a Drscreaancl md,catior Snact �� Partial Refection r 1 Full Refection >- 18b. Alternate=acittiy for Generator: MVIles! Re!ererne Number. -� U.S. EPA ID Number Q Facility's Pnonc Aj u 18c Sip n iture of Allemaie Facility for Generator S Month Day Year Wasteen1P Hazarouus Rport Managernen- Method Coags 6 e cones Icr n zaroous wast e iremmen: disc ar„ riw:a r LJ ,q- , tristerns. ns m tertai ^wr•r � er b. !nr. ^.�3n�ier' e'•. e: ::•rar.r m tt,;...:ist 2i Geslpnaten -acdnv lrwnp• ar C.it+ernn er.,t:rallor, pi rec,eip! e' nasaro %'flll(ed. i i'ULd (tlamt • r--. /% Mang � �'1 \ Gay 'Yea, ill^onr.•�iCi,.. _ �/ � ,- r ,-�� —._ i i• ) �' �. �� Kg.