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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1. enemtor ID Numbe ¢ 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST fly t g p q 1 1-800-424-9300 002390236 1 K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) C,¢ , Geflerator's Phone: J52 6.Transporter 1 Company Name U.S.EPA ID Number Evergreen Environmental ervices CAD982413262 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Ever reen Oil, Inc. 6880 mith Ave. New rk,CA 94560 Facility's Phone: 510- 95-4400 CAD980887418 ga 9b.U.S.DOT Description(including Proper Ship Ing Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13,Waste Codes HM and Packing Group(if an, No. Type Quantity Wt.Nol. l �SZ7 -- 9 �R Z 2. W 3. 4 14.Special Handling Instructions andAdditional Informafi n 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I t ereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respe s in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignor nt conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identi led in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Si natureMonth Day Year Generator'sl0�tnc's Printed/Typed Name / , 9 cam%6 J 16.International Shipments !— ❑Import to U.S. Export from U.S Port of en ry/exit: Transporter signature(for exports only): Date leaving U.S.: IX LU 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedlT d re Name j/ Signatu41W Month Day r O CL QTransporter 2 inted/Typed Name Sign re Mont Day Year H 18.Discrepancy 18a,Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Altemate Facility(or Generator) U.S.EPA ID Number J_ V LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are o solete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)