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JUN-27-06 11 :08 FROM-Evergreen 0' ' 5107962559 T-150 P 002/002 F-389 <br /> Jfote or�ainvrnr�—���•� ���••��•�• •- - - - Daporlmanl 01 Toxic 5vb3taneal Centro; <br /> JgE II15ffUutanS un uus.w yr v. <br /> 1Form Approved OMB No.2050-0039 IExP;res 9.30-991 Socramenio,California <br /> Pleasa print or type. Farm designed For use on elite f I2-pitch)bh rr. <br /> 1. Gonerolor's US EPA ID No. Monffetl Documant No. 2. Page I Informalian in rhe Shaded areas <br /> UNIFORM HAZARDOUS is not regvired 6y Fcdoral lay. <br /> WASTE MANIFEST / y / S IS, of 1 EES4 <br /> 3. Genaratof s Name and Melling Address <br /> A. 51ale Mor,&sl Document Number 24734198 <br /> (.p< 7'rAvi ST J%cCkTG G► <br /> /�01.f f_ Q grzo G B. State Ganerotor'n ID <br /> O _I <br /> a. Genoraror's Phoneri(r 1 <br /> 7 Transporter 1 Company Nome 6, US EPA ID Number C Stato Transporter's tD j oso d.1 <br /> EVERGREEN ENVIRONMENTAL SERVICES D, TronsporWi Phone <br /> c CAD 0 8 2 4 1 3 2 6 2 (800) 972-5284 <br /> 0 <br /> C? 7. Transporter 2 Company Namu B. US EPA ID Nvmber E. SiamTroneponer's fD JRaserved.J <br /> F, Tronipor+ars Phone <br /> 43 9, pori noted Facili Namo and Site Address 10. US EPA ID Number G. Slate Fociliys ID <br /> r Q E bndl--- bIL,INC. IC JA 11119 1810J8 18171411 8 <br /> Z 6880 Smith AVenue 3 H. Facility's Phone <br /> o Newark,CA 94560 C A 019 8 0 8 8 7 4 1 8 (510)795-4400 <br /> J-= 12, Container 13. Total ld, Unit <br /> I. US DOT Dascriprion(including Proper Shipping Name,Hazard Clans,and ID Number) No. T C1vanG Wt/Vol 1, Waste Number <br /> 5toto <br /> z 0. Oi'C d— Iv7'Pa- ZZ/ <br /> G NON•RCRA HA7AADOUS WASTE,LIQUID 0 �0 1 T T o G EDA/puna <br /> E b SlatelY <br /> o N <br /> E EPA/Other <br /> v R <br /> A c State <br /> o T <br /> W O EPA/Othar <br /> R I <br /> slat* <br /> w d. <br /> w EPA/Other <br /> V <br /> w <br /> V) J, Additional Descriptions for Mulariolr Listed Aho" K, Handling Codes for Wallas L steal A o 0 <br /> z o. <br /> O <br /> N <br /> 7—B <br /> Q Po Qo t a S <br /> Z 15. Spacial Hondling Inslrvctions and Addlllonol Information <br /> ° 24 Hour Emergency Response Telephone No., CHEMTREC 1-8U0-424-9300 Invoice f 3oz PP 9 <br /> z DOT ERG 171 WEAR PROTECTIVE EQUIPMENT Sales Orders wc,oe,y9eUJ7 <br /> w <br /> r <br /> r <br /> 10. GENERATOR'S CERTIFICATION_ I hereby declare that Ike canionh of this carnignmenl oro(ully and ocevrolalyd0xribed above by proper shippIng name and are classified,pecked. <br /> Q marked,and labeled,and are in all rospoch in proper rendition for Irensparl by highway according to applicable Intomodonal and notionol govammoni noelllarions. <br /> U <br /> f I em o large quanf,ry gonerolor, I certify Ilial I have a program in place to reduce tha volume anal IoRicity of wattle genararod la the degree I have dalorminod'!o 60 eronomica YY <br /> p- praclicololo and they I have selected the pracffcoble mathod of treatment,swag.,ar disposal currently ovaila6lo to me which minimizel the presenr and future throol to human hoolth <br /> vi and tho environment;OR,if I am o small quamlily ganerotor, I have mode o good faith offort to minimize my vrasle generalioe and:01ec1 rho tool vests manogemont method that is <br /> available to me and rho,I can afford, <br /> OPrinted/T ed Name Slgnalvre Month Doy Year <br /> U Z o <br /> 0 T 17. Trans orler I Acknovvlecl emast of Recel t o muferlofs <br /> R $Ignaruro Month Day Year <br /> N Prir d pod N e <br /> S r� u v <br /> z y' r <br /> Q U 19, Transporter 2 Acknowled ornant of Recai l of Malerials <br /> R Prinled/Typed Name Signolora rtionlh Day Yeer <br /> T <br /> - N E <br /> Q R <br /> U 19. Discrepancy Indication Spom <br /> z F <br /> A <br /> f <br /> L20. FacilityOwner or O orator Cerllficolion of reroi t of ho= rdaus md1orialt covered this monil0st oxca s noted in Item 19. <br /> T Prinbd/Typed Namo 5ignowr 7Month Day Year <br /> y �� O <br /> DO NOT ITE BELO IS LINE. <br /> !61c fSDf SEPdDS Irlt:: !:C)P'! 71) fYti,. <br /> DT5C 9022A 11/99) 7r.. 0.0 S,,n 300'j \acr.tntew.). <br /> EPA 9700-22 <br />