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i <br />f <br />v <br />C <br />z <br />tY <br />LL <br />LL <br />C <br />U_ <br />Q <br />U <br />VA <br />State of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-99) <br />Please print or type. Form designed For use on elite f f 2-pitchhilkgwriter. <br />See Insthictions on back of age 6. Department of Toxic Substances Can <br />DO NOT WRITE BELOW THIS LINE. <br />DT5C 8022A (1/99) White: TSDF SENDS THIS COPY 'O DTSC W!THIN <br />EPA 8700-22 To: P.O. Box 3000, Sacrcmenro, CA 95812 <br />UNIFORM HAZARDOUS <br />` <br />enerator's US EPA ID No.: Manifest Document <br />2. Page 1 <br />Jocromento, Calitornia <br />Information in the shaded areas <br />WASTE MANIFEST <br />® ® Z <br />is not required by Federal law. <br />% -? <br />Z ® <br />of <br />3. Generator's Wame and�p 'long Address <br />S�112/° v <br />�./tPOT 47Are- 0IJJ G = <br />sem. n << <br />� . <br />� ' �, b�axVK0001, -too <br />r � 3 <br />�+�TNarrP s3 �d <br />4. Generator's Phone { '� ) A/ i,`2W <br />7 <br />gyp®® <br />, � <br />r a <br />j <br />®64 <br />s <br />5. Transporter 1 Company Nome 6. US EPA ID Number <br />C Stater iD <br />a° <br />o <br />EVERGREEN ENVIRONMENTAL SERVICES <br />x <br />CAD 9 18 2 14 11 13 12 <br />6 12' <br />7. Transporter 2 Company Nome 8. US EPA ID Number <br />5m284 <br />J <br />�x <br />V <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G_ State Facddy(s <br />z <br />EVERGREEN OIL, INC. <br />_r' <br />6880 Smith Avenue <br />4 �t 8 <br />=H. Facility's PhoneNewark. <br />CA 94560 IP I A IM 19% 1 <br />510 7954400 <br />JUS <br />DOT Description (including Proper Shopping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total 14. Unit <br />No. <br />Type <br />z <br />a --� <br />Ott 4/�7fjZ <br />I Quantity Wt/Vol <br />1:h Waste Number` <br />States <br />NON-RCRA HAZARDOUS WASTE, LIQUID <br />I <br />E <br />0 <br />01 <br />T T <br />o 7 SX (; <br />Ef'4lOd'er <br />? N <br />b. <br />s, <br />Stam <br />E <br />7 <br />EPA/Other <br />A <br />I <br />T <br />oO <br />` <br />State <br />- R . <br />C <br />i <br />EPA/Other <br />J <br />d. <br />s <br />State <br />J <br />J <br />I <br />EPA/Other " <br />J. Additional Descriptions for Materials Listed-AF604e: <br />K. Handling Codes For Wastes listed Above <br />�' t <br />n. b. <br />f <br />m <br />a� <br />a <br />d <br />j <br />15. Special Handling Instructions and Additional Information <br />24 Hour Emergency Response Telephone No.: CHEMTREC 1.800-424-9300 <br />Invoice # 111 Co <br />OOT ERG 171 WEAR PROTECTIVE EQUIPMENT <br />Sales Order # lbs W / <br />16. GENERATOR'S CERTIFICATION: 1 hereby declare mat the contents of this consignment are fully and accurately described above by proper shipping acme and ore classified, pcckea. <br />marked, and labeled, and ore in all respects in orccer condition for transport by highway according to international <br />applicable <br />and national gover-meet regulations <br />" I am a large quantity generator, 1 certify that I have a program in pioce to reduce the volume and toxicity of waste generated to the degree I -eve determined to be economically <br />practicable and that 1 have selected the practicable merhod of treatment, storage, disposal <br />or currently available <br />and the environment; OR, if 1 am a small quantity generator, I have made a good Faith effort to minimize my <br />available to me and that I can afford. <br />to me which minimizes the presect and Future threat to human. ;:city <br />waste generation and select the best «ante management method that ;s <br />Printed/Ty ed Name Signature <br />Month Ocy e Year <br />T <br />R <br />17. Transporter 1 Acknowledgement of Recei t of Mater =is <br />A <br />P m d/Typed a I5i r <br />R <br />S <br />P <br />O ��/K� I <br />'KJ�0 <br />Month Day Year <br />(0 1 io�I <br />0 <br />B <br />18. Transporter 2 Acknowledgement of of Mater -=is <br />Printed/Typed Name Signature <br />! <br />E <br />R <br />Month Da Y <br />Y ear <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />1 <br />L <br />1 <br />20. Facility Owner or Operator Certification of receipt of iazardous materials covered by this manifest :xce t as noted in item 19 <br />T <br />Printed/Typed Nome Signature <br />Month Day year <br />i <br />DO NOT WRITE BELOW THIS LINE. <br />DT5C 8022A (1/99) White: TSDF SENDS THIS COPY 'O DTSC W!THIN <br />EPA 8700-22 To: P.O. Box 3000, Sacrcmenro, CA 95812 <br />