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DEC-05-03 17;56 FROM—Evergreen Oil 5107962559 T-482 P 002/002 F-407 <br /> arm Approved OMB No-2050-0039(Expires 9.30-991 leo true u,.ttuna Ott vs�usc vs s+uac W. Deportment of Toxic Substances Control <br /> lease print or type. Form designed for use on elite 112-pirch' (Triter, Sacramento,California <br /> seneralof s US EPA ID No. Manifest Document 1—. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law, <br /> WASTE MANIFEST 0 S7/ l 9 -r G -2 2 of J <br /> 3 Generator's Name and Mailing AddresG $/T�' <br /> G�CT7CJ C. �- S/S� <br /> 4'v. BdwX� 93� <br /> CA <br /> 9y,fZO <br /> r <br /> In A. Generator's Phone ( 1 <br /> Z. 0, - <br /> S. Transporter 1 CorRpany Nwp�,� oj EPA ID Number <br /> h00 <br /> #/wr _. sem. p 7 9 <br /> 6T 7. Transporter 2 Company r4arna S. US EPA ID Number <br /> J <br /> 7a - <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> 12. Containers 13. Total 14. Unit <br /> :)< 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) <br /> ,v No. T pe Quantity WI/Vol <br /> 02 a /1 OW CLQC f1_ 15A*vsy`�"f-f LJ <br /> 3 c <br /> 60'//-Y / #'v d <br /> N <br /> E b. <br /> o N <br /> 0 E <br /> R <br /> A - <br /> o T C. <br /> eco O <br /> R <br /> Z <br /> w <br /> Q r do �� 'G �... , "'ir:?Sv,;s,�r,� i d'e!'?• .,;1.`� �h'.'u�"'d a..., :i1- _'.i'Li;�'l"....' <br /> Q 15 Special Nandi;nig Instruct ons and Additional Info atian A-� (� /�~ <br /> ����: <br /> LJ <br /> = 3239 <br /> I- <br /> 16. GENERATOR'S CERTIFICATION_ I hereby declare that tho contents of rhis consignment are fully,and accurately doscribed above by proper ship ;ng name and aro classified,packed, <br /> Q marked,and labeled,and are;n all respects in proper condition for transport by highway according to oppl;coble;nloma6araI and national government regulations. <br /> U <br /> J <br /> if I am o large gvanli generator,1 certify that I have o program in place to reduce the volume and toxicity of waste genera tad to the degree I hove detsrmincd to be ecanomiCollr <br /> Practice <br /> and that 17. selected the practicable mnihod at treotment,sloraga,or disposal currently available to me�h;ch minimizes the present and future threat to human health <br /> oC and he emrironmenl;OR,if I am o small quantity generator,I have mode a good faith effort to minimize my waste generation and select the best waste management mothod Phot is <br /> C) o-oiloble to me and that I can afford. <br /> YPrinted/Typed ante ' Signature Month Doy Ysor <br /> U / <br /> W 1 17. Transporter 1 Ackrowiedgement o7 Receipt of Moterials <br /> Ce N <br /> w APrinred/Typed Nome Slgnatare Month Day Year <br /> RS 44VR-�,o iJ li�� D Z <br /> W <br /> P <br /> s` 0 18. Transporter 2 Acknowled amen?of Receipt of Materials <br /> 0 1 Primed/Typed Name Signature Marlh Day Year <br /> w E <br /> Q a <br /> V 19. Discrepancy Indication Spare <br /> Z F <br /> — A <br /> C <br /> I <br /> L <br /> 1 20. ociliry Owner or O arotor Certification of receipt of hazardous materials cc-ered by this ma " ex t as noted in Item 19 <br /> T Printed/Typal KN Signature M ht Day Year <br /> DO NOT WRITE BELO HIS LINE. <br /> DTSC 6022A (4199) White: TSDF 5CNDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 0700-22 To. F.O. Box 3000, Sccratronto, CA 95312 <br />