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I Generators US SPA ID No 2 Page 1 3 Document Number <br /> HKZAR000S r'= of <br /> - STiVANIFES7'Y = <br /> NH- ' 1701 <br /> 4 Generators Name and Mailing Address EES 19 <br /> S431C1\ *, <br /> 1'31 C` Cy ; <br /> SAQck4C_. <br /> Generator's Phone <br /> 5 Transporter Company Name 6 US EPA ID Number 7 Transporter Phone <br /> EVERGREEN ENVIRONMENTAL SERVICES <br /> CA0982413262 800-972-5284 <br /> 8 Designated Facility Name and Site Address 9 US EPA ID Number 10 Facility s Phone <br /> Evergreen Oil, Inc <br /> 6880 Smith Avenue <br /> G Newark, CA 94560 CAD980887418 510-795-4401 <br /> E11 Waste Shipping Name and Description 12 Containers 13 14 <br /> N Total Und <br /> E No I Type Quantity WWoI <br /> R a <br /> T Non-Hazardous waste, liquid 001 TTL � �7 J— G <br /> O Water and oil <br /> R b <br /> is Special Handling Instructions and Additmonat Information Handling Codes for Wastes Listed Above <br /> Ila lib <br /> Profile# <br /> Do not ingest 7 r 7 5- <br /> ,Wear protective Clothing Invoice <br /> In case of emergency call CHEMTREC 800-424-9300 Sales Order cl E,) d�6{�y <br /> DOT ERG 171 <br /> 18.pt.fdEFWdR'S CFATInCAnON y I certtry itik niatenais desorrbed above on flus m`anoesl ars not Subject to state of iederal iegalatfon;for,reporturg proper dtsposal of Hazardous VWasta- <br /> Pnntedrryped Name Signature <br /> _ th MDr-a Year_ <br /> 5 17'T +s+r� a- sw. Otl' S�t> �'v 4 .r r}' 0^' �r�rxn 3!%"ryjils3st �1 �C7r �ai4f+} z �Yu +�= ti 4ztL3���. Ss <br /> OPnntedfTyped Name Signature 1 <br /> R ! C I y` i 1.�4 LLf]r i Month Day Year <br /> R <br /> 18 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> rf <br /> L <br /> �f <br /> � a,; w�:,s- <br /> .c...mx�..�a�'= <br /> Printednyped Name Signature <br /> Month Day Year <br /> WHITE—ORIGINAL(Return to Generator) YELLOW—TSOF(Retain Copy) PINK—TRANSPORTER COPY GOLDENROD—GENERATOR S COPY <br />