Laserfiche WebLink
tie of 4a[11orni"nvironmental Prateellon Agency See Instructions on back Ir` `-ag T�oarfm,rt of T—ie SubsJonce-CdntrO <br /> r,,,Apprevad OMB No.2050-0029(Expires 9-30-99) 5acromenio.Californlo <br /> ,osa prim or type, Form designed for use on elhe 112-p1 4 ewril-r. - <br /> Monileil Document No. 2 Page 1 Warnsation in Ilia shaded arev- <br /> 1, Generator's US EPA iD No. snot required by Federal low. <br /> UNIFORM HAZARDOU5 �9 <br /> WASTE MANIFEST !i ar <br /> A. Slee nr,ontFe-�Dacvn+ent Numisa• 2 �`2 7 4 0.8 4 <br /> 3. Generolof's Name and Moiling Address ��j �s,►/��,l� <br /> ��/' -S L��/7.f�FJ!�[�•C:�'�!/�-''�,� B. Slate Generator's ILn <br /> 4. Generator's rhorw ]�� <br /> 6 5 PAID Num6or C. 5loln Tronsp rear's ID IReemvod.] <br /> 5. 7ransPorla•1 Can+pOny ame �����}y,,//�� <br /> �- D, 'fronsporter's Pho�c 51Q-795"s"rin� <br /> EvergreenBrcvironmental �e ices CAD 9 <br /> E. State Trvnsporler's Ip <br /> 7. Transporlar 2 Compony Name <br /> E. US ErA ID Numbwr ]Reserved,] <br /> P, Transact*+or•:thane <br /> ID Number G. Stole Facility's ID <br /> 9. Designoled Facility Nome and Silo Address <br /> l0. US EPA <br /> Everueen OiL Inc. H, Focilily's Phone <br /> 6880 Smith Ave <br /> lit', CA Q4998'. <br /> y, aniainer5 13. Tolol 1 d, Unit <br /> 11 US DOT Deseriplion{including Proper Ship ing Nome,Horord Gloss,and 1D Number] No. Tye C)uo lily <br /> WI/V01 I. Wools Number <br /> � Stake <br /> c a. ?j �U� Y"� � ✓��/r F✓� ., EPA er <br /> � State , <br /> I <br /> E <br /> bEPA/Other <br /> 5 (J <br /> 0 1= <br /> State <br /> vc <br /> j T EPA/Other <br /> O <br /> R Slate <br /> Y d. <br /> L <br /> _ EPA/Ober <br /> z <br /> L <br /> J " <br /> K. Handling Codas For Wailes LlsleCl Above <br /> /� J. Adds+tonal Deseriptionz for Mo+ariols listed hove a. <br /> It. <br /> 0 � <br /> W <br /> U-1 <br /> 4 <br /> z 15. 5pnciol Ha4ing Instruellon�s and Ad,dlto of I-formation <br /> o <br /> 24 Hour Hmm-gen=7 ReSponse k. <br /> z ERG#: )7/ Chemtree SM424.9300 <br /> -6 proper shipy'Ing name one ore clossif;od,pocked. <br /> H t full and oc[urate described nali,by p p <br /> J 1 6. GENERAT'OR'S CERTIFICATION: I liar ab <br /> declare hal the cvn+enrs of this can are Y ,cable War <br /> and notional governman!regulolions. <br /> t cr condition Jar+ronsport y 1,ighway according to vpp <br /> on are in all res cls in 0 oP <br /> U marked,and lobeled d P <br /> ro tont in lace to reduce the volume and Toxicity al wasm generolacl b Ilia degree 1 have determined to be economical) <br /> .Js If I am a large gvanli generotor,I cert Ip lhvt 1 have a p P m 10 to ewhichon and:aletll the best waste monogemenT method that is <br /> i% proeticobla and that I ho.e selected the oeilCable-olhad of lreotrnanl,storage,or dispowl currently ovoifvble to me which miand es Ibt present and future ih+aal to human heap <br /> N and 11,e anvironment;OR,iJ I om o into quanllly generator,1 have made a goad Ivitlt effort Io minimize y b <br /> rx ovoilable to me,and Ihtll I can offord. i�onll+g oy yr <br /> O 51gnafu (ftL� <br /> - Prinj,4i06 <br /> 4 Ped Noma y � <br /> w ✓onih Day Year <br /> T 17 Transporlcr 1 AC ow od emnnl of RoCei t of Mtltoriols Signo urn a <br /> Q prinlee/TypLL ed Noma i <br /> IM P Month Doy Yeor <br /> U- p 19, Trans on Aeltnowla ement o ecce t of Mtl ariols Sign ature <br /> O R Printod/Typo *me <br /> T <br /> tUj E <br /> UR 19. Discrepancy Inciieallon Space <br /> 9 F <br /> A <br /> C <br /> l noted in Iram 19. Year <br /> - bAonth DoY <br /> ] 2D. Fadlit Owner Or O eraser Corlifiwllon of recai of hazardous male rials covered b this mani4esl exec I tlV_ <br /> 5ignalu•a � � p -7 <br /> T Printed/Typod Nome <br /> YFrYA LV ti <br /> DO NOT WRITE BELOW THIS LINE, <br /> Vrhii¢ TSDF s111NN THIS COrY TU DISC WITHIN zti DAYS. <br /> To, P Q. L'a.. ?n(n Sncra,nenta, CA 95812 <br /> . - <br /> IVI-d E00/E00 d 968-1 0888 VVI 019+ HAON DABS a3NO1Sn N33dnd3A3-NUd INVSd:II 8002-91-d3S <br />