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UP <br /> U-v V,w91IfornIQ—I;nwronnlehIa1 FroleCNoh Age cyrm Approvod OMB No,2050-0939 IExplres 4- 0-49) See InSfrurtionS on batik ^r le 6. Deporunent of Toxic Substancas Cenh <br /> eoso print or typo. form designed for use on el Ie(12-pi )writor. Sacramento,Coliforaio <br /> UNIT SRM HAZARDO 5 �' Generolor's US EPA ID No. Manifest Document No. 2. Pogn 1 Information In the shaded prao% <br /> is not required by Federal low. <br /> WASTE MANIrm C ,e I 9il of'1 EE54 <br /> F3. Gor,rrolgr'a Name and Mailing Address A. Stafo Manifest Deeitmont'Numbor— <br /> r„ <br /> 5'4,ubor C iL ev <br /> s.- elf Gte�e 2':x,:7:3 0 5 9 8 <br /> �c- 9 f 1 yo B. S1ata Ganerator's ID : . <br /> nd- Generator's Phalle <br /> In In S. Tronsporlor 1 Company Name 6. US EPA ID Number C. State Trpnoporler's(D(Rnsdrva J. <br /> m <br /> o EVERGREEN ENVIRONMENT L SERVICES Alp g g 2 4 1 3 2 6 2 Traneparlar's Phana,' , . b)_"972=5284 <br /> 7. Trans rter 2 Com an Noma <br /> _ Po P Y 8, US EPA Ib Number G..Slate Transporter'%ID R. rwv :.�?',,.• <br /> 4 •F. Tronshorler'o-Ph-ha I: , <br /> U 9, Deslgcatad Facility Name and Site A drass 10. US EPA ID Number G:•5101e Faclllly's ID,: _ ,..�-•• <br /> =Q EVERGREEN OIL,INC. <br /> Y? 6880 Smith Avenue N, Faea ty's Fkona " <br /> Newark CA 9456a CAD 918101 81817141118 <br /> �u 11. US DOT Description(including Pr*4 Shipping Name,Hazard Cless,or,d 1D Number) 12. Containers 13. Total 14, Unit <br /> No. Type Quantity Wt/Vo! .6;'7/Jgito Number <br /> z a. <br /> NON-RCRA HAZA OUS WASTE, LIQUID <br /> aid;her <br /> E 0 0 1 7 T Q G None <br /> a N 6. <br /> Slate' <br /> o E <br /> 12 I LPA'/Other <br /> V A e stole' <br /> o T <br /> m 0 <br /> R EPA/bfkcr <br /> LU 1 d Stale <br /> z <br /> LU <br /> 41 EPAy011stlr <br /> W <br /> L J. Additional Dascripilons.6e Materials iii ad Abp4Q K, Handling Codes for Wastes LisledAbore <br /> o a: 6 <br /> LU <br /> ProfifefP d. <br /> a - <br /> z <br /> O 15. Special Handling Instructions one Add llonof Information <br /> 4 24 Hour Emergency ResponS Telepone No.: CHEMTREC 1.800-424-9300 InVOIC0 <br /> DOT ERG;# 131 WEA PROTECTIVE CLOTHING Sales Order#G.00v 7e 6 <br /> 16. GENERATOR'S C'EBTIFICA'n - I hat by declare Ihat the contents of tl+is Consignment are fully one oeeurolely doscribee above by proper shipP ing name one are c6ssifiad,peeked, <br /> Vmarked,and labeled,and ore!n all re pacts in proper cOndllion far Iron%port by highway according to applicable international and nptlpnal gowernmenr regulations. <br /> -+ If I am a largo gvontly generator,I c rtify,that I have a program in place to reduce Ike vafumc and toxicity of waste generated to the degree I have determined to be oconomicpllyy <br /> V) procticoble and That 1(,ave selected th practicalslo method of treatment,storage,or disposal currently available to me which minimizes the present and Future Throat to human heahh <br /> and the environment;OR,if 1 pm a Stn II quantity generator,I have made o good faith effort to minlmlze my wasto generation and select the host waste management method thpl Is <br /> ovalloble to me and Ilial 1 eon afford. <br /> UPH d ypad Name Signature Montk Day Your <br /> z � <br /> LLJ E 17, Trans orler I Acknowied ement of Rec i t of Materials <br /> BPrimce/Typeel Name Signature Month Day Your <br /> N 6 6 <br /> Qn!0 18, Troortar 2 Acknowled em, of Roc Rut of Motorialt <br /> Month Day Year <br /> y Printed/Typed Name Signature <br /> "0 E <br /> < B <br /> Q <br /> V 19. Discrepancy Indication Space <br /> z f <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Qwner or Operator Certlficof;or,of receipt of hazardous moteriol%cowered by this manifest except as noted in Item 19. <br /> T Prinled/Typed oma Signature Month boy Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DT5C 8022A (1/991 Whilp. T5Dr SENDS 'THIS COPY 'CID DTSC WTTHIIV ?O DAYS. <br /> EPA 8700-22 Tri; F.Q. Bex :3000, SUCritn»nl'), CA 95812 <br /> lbl-d £00/Z00 d 968-1 0886 M 015+ HAON 301A0 63NOX0 N33 U3A3-N0ad NV£Z:11 800Z-91-0 <br />