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Fax Server 8/6/2015 4 :01 : 05 PM PAGE 23/046 Fax Se>p ECE1VEE <br /> 0 AUG 0 6 2015 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> NON-HAZARDOUS 1.04inxabrbUSE Na klan'Aed Tini�. <br /> WASTE MANIFEST }/. °oc""a"MN NHS F} nco. <br /> 3.Genealots Name end maAing Addles -7Z fo 7. a 11 11.11 T <br /> �1$�©©P IN 5T21 F5 DBk*pp c' IiVJF IN C <br /> 4.Ganeratoes Phone Y.0 9S3—3Lbc <br /> d CkR CIS '06 <br /> s.TansPgte�l om yN��f^a�� �y� <br /> yr £ da I..GFiN vyS ,� INC- S' A.Stale TamporbYSID <br /> ].Transpdter 2 Company NemoS.Taraporler 1 Prone 510 795.4400 <br /> 8. US EPA ID NUmber C.Sate iargponefa ID <br /> 9.Designafetl FfldNy Noma an0 SNe Adtlresa13.1ireraporler2 Phone <br /> 10. US EPA ID Number E Slate PaeIINys ID <br /> EVERGREEN OIL,INC. <br /> 5950 Smith Average F.Foally's Phone <br /> Newark CA 94560 CAD990897418 510 7 4400 <br /> 11.WABTE bESCRIPTION <br /> lz comm ta. 1a <br /> Twat Unit <br /> a. No. Type ownrity WtIvol. <br /> Non-Hazardous waste,liquid <br /> b. 001 TT ©[0 G <br /> E <br /> N <br /> E <br /> A o. <br /> T <br /> O <br /> R a. <br /> UJ <br /> N <br /> 3 G.Aaalionel De p ions to Maledals etl Above H.Hargrmg Codes for Weates Udea Abse <br /> to <br /> 7 <br /> O <br /> O <br /> R' <br /> 15.Spedal hlerfdNrg Inslrudlolro and AdtlNbnd Inbmatlan <br /> Proflle A' Imroioe: OCI�ZZ 0� <br /> ODo not ingest Sales Order. <br /> Z Wear protective clothing <br /> In case of emergency call:CHEMfREC 800.424 9300 <br /> 16.GENERATOR'S CFATIPICATION:trrerebey<ertiry that the contents d bis stipment are gulpp,,antl amualely described and are in all respeds <br /> in properngndNbn br trenspm.The mate els tleacdped on lids-Sellare not aublad toledeal hanardaue"Ste negdations. <br /> PrintO YP�ame , �\ Date <br /> \e Signalure <br /> v�n <br /> Month Day Yeer <br /> it a 3 <br /> T Trans e � scalp o a <br /> APrinle Name Signa, <br /> AI nm Gay Ye9r <br /> O 9.T edge ` ms � (b 1 <br /> PdnleMypad Name Signature <br /> R Manfh Day Yeer <br /> F 1B,piscrepentylrrdcatlon space <br /> A <br /> C <br /> 1 20.Fed ib ow <br /> L 71.CenN on 01 recept of be wade mat0dalS covered by bis manlfed,except as mtW In Item is. <br /> { <br /> 1 l <br /> ;✓j PrinkyiyryedName glgrWwa t <br /> Y 6 ' Mo�� y Year <br />