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't Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-00:. UNIFORM HAZARDOUS 1.G orator/ID Number / 2.Page 1 of 3.Emergency Response Phone 700239048 nifest Tracking Number WASTE MANIFEST NZ/ �a'Z ! 1 1-800-424-9300 9 JJ K 5.Generator's Name and Melling Address Generator's Site Address(if different than mailing address) wit . Ge rat s hone: �� S� 6.Transporter 1 Company Name U.S.EPA ID Number Evergreen Environmental Services CAD982413262 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 Facility's Phone: 510-795-4400 QAnciAnFtR741,q 9a. F-,di`P..ldng S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM Group(If any)) No. Type Quantity Wt.Nol. 13.Waste Codes Z 2. UJ 0 3. 4. 14.Special Handling struclions and Additional )Ion � zx� 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 condltfon 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 EPAAcknowledgment of Consent. I certify that the waste minimization statement Identified In 40 CFR 26227(x)(if I am a large quantity generator)or(b)(III am a small quantity generator)is true. Generator'slOfferor's PrintedlTyped Name Signet l Month Day Year 100 P� =J 16.International Shipments r— ❑Import to U.S, ❑Export from U.S. Port of ent rylexil: 2 Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Pirintep p d Name Signature Month Day Year �6 a Cn 42 Transport Printed[TypatrN6me Sign re Mon h Day Year i r- 18:Discrepancy 18x.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b,Alternate Facility(or Generator) U.S.EPA 10 Number ,J U ua. Faclllty s Phone: C1 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z 19.Tdazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) UJ p 1 4 � 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 PrintedrTyped Nam Signa t Month Day Year a M I Jv EPA Form 8700-22(Rev.3-05) PreviouV editions are obsolete. IONATED FACILITY TO DESTINATION STATE(IF REQUIRED)