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r hi fFnrm riocinncri fnr n olifc f17-nifrhl fiin irifor \ Form Approved. OMB No. 2050-0039 jNIFORM HAZARDOUS I. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number 1 1-800-424-9300 JJ WASTE MANIFEST C ��09Gli S 5. Generator's Name and Mailing Address l✓ Generator's Site Address (if different than mailing address) ///�//��- 4/` 111 Generator's Phone'S 6. Transporter 1 Company Name U.S. EPA ID Num er Evergreen Environmental Services CAD 98413262 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number Evergreen Oil, Inc. �_ 6880 Smith Ave. Newark, Ca. 94560 CAD980887418 Facility's Phone: 510-795-4400 9a9b, U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity WLNol. r / y r 6-/ LLI 3. 4. i 14. Special Handling Instructions and A ditional Information �f�--.s-0a3i 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeledlplacarded, and are in all respects 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 consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I ama large quantity generator) or (b) (if I am a small quantity g6nerator) is true. GeneratoeslOfferoes Printedrry�pedd Name Signature Month Day Year —J16. F.— International Shipments ❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: Z Transporter signature (for exports only): Date leaving- U.S.: - W 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Type Name Signat Month Day Year CL. z¢ Transporter Pdntedffyped Name Signature Month Day Year tr F- 18. Discrepancy 18a. Discrepancy Indication Space ❑ QuantityType E]❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number U Facility's Phone: Lu 18c. Signature of Alternate Facility (or Generator) Month Day Year Q z N 19 -Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) � 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 edi(ions are obsolete. DATED FACILITY TO DESTINATION STATE (IF REOUIRED)