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i <br /> ��wf» I Generatoes us EPA 1D No 2.Page 1 3 Document Number <br /> Of <br /> 1 <br /> NH- Ru 13154 <br /> 4 Generator's Name and Malting Address EES <br /> 19 <br /> 1 r,t�or q/. SAC rF-^4Wr'D' <br /> Generator's Phone S-.r <br /> 5 Transporter Company Name 8 US EPA ID Number 7 Transporter Phone <br /> EVERGREEN ENVIRONMENTAL SERVICES <br /> _ CA0982413262 800-972-5284 <br /> 8 Designated Faaldy Name and Site Address 8 US EPA ID Number 10 Facility's PhDn* <br /> Evergreen Oil, Inc <br /> 6880 Smith Avenue <br /> G Newark, CA 94560 CAD980887418 510-795-44fl1 <br /> 14 <br /> E 11 Waste Shipping Name and Descripton 12 rs TSI unit <br /> N <br /> E No Total <br /> WtNol <br /> A allon-Hazardo�Slaste, liquid <br /> O Water�an of <br /> 001 Tr Jf G <br /> R b <br /> 15 Special Handing Instructions and Addthonal Information Handling Codes for Wastes tisted Above <br /> 11a 11b <br /> Profile# <br /> Do not Ingest <br /> Wear protective clothing Invoice. ?16-k5l <br /> In case of emergency call CHEMTREC 800-424-9300 Sales Order <br /> DOT ERG 171 f <br /> �T.,t, I,:.a i r� / /'� 7 G �vc.•T'c 5 �'l�•� lll,.� ST�1�T�.- fr' <br /> 16 GENERATOR'S CERT11MATIO!) +ids wash <br /> Pnntedfryped Name Signature <br /> }� Month Day Year <br /> A <br /> S17 Transporter <br /> P Pnntedlryped Name Signature <br /> O <br /> R r Month Day Year <br /> R . <br /> 18 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 9 Facthty Owrrer a <br /> Printedfrypsd Name Signature <br /> Month Day Year <br /> i <br /> 1 WHITE--ORIGINAL(Retum to Generator) YELLOW—TSDF(Retain Copy) PINK—TRANSPORTER COPY GOLDENROD—GENERATOR'S COPY <br /> i <br />