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. ..f+"t'a='Rn��slZ'�^ ..•y^' � ,i-r���Xµ; '- ,.'^....ti.FF�cti _ ari , ��;( ,r_,� ..�,....�...---•. s.-."--•ch�,.l,�„-rv-.,t_�.,�,�.rS.,F <br /> r +` <br /> � y <br /> 1 Generators US EPA ID No 2-QP'ge 1 3 Document Number' � <br /> _ NH- ` f 7 <br /> 6 <br /> ` 4 Generator's Name and�Ma[liress r EE <br /> Add � <br /> a r .Q.7 /V 0_0 <br /> �3 S� �• 13P�► r►�tlL s�-" <br /> c�x.Ck Ajo0 Cv4 q 5? 1(o <br /> Generator's Phone Cil tR— '� 3 <br /> 5 Transporter Company Name a us EPA ID Number 7 Transporter Phone <br /> s EVERGREEN ENVIRONMENTAL SERVICES <br /> CAD982413262 800-972-5284 <br /> + 8 Designated Facility Name and Site Address 9 US EPA M Number 10 Facitity s Phone <br /> a` <br /> r ' <br /> s Evergreen Oil, Inc <br /> 6880 Smith Avenue <br /> V Newark, CA 94560 CAD980887418 510-795-4401 <br /> N 11 Waste Shipping Name and Descnpbon 12 Containers 7 3� 14 <br /> Unit <br /> E Na T Quan WVVol <br /> A a <br /> Tr Non-Hazardous waste, liquid r� <br /> O Water and oil 001 TT 3 g`3 G <br /> R _Tb <br /> r <br /> T <br /> 15 Special Handling instructions and Addrbonai Informabon91'-le L 6 t-A 41 0-A./ Banding Codes for Waatert Usted Above <br /> Ila. 11b <br /> Profile <br /> Do not ingest S��k� <br /> Wear protective clothing CA Invoice - <br /> In case of emergency call CHEMTREC 800-424-9300 Sales Order <br /> DOT ERG 171 _ <br /> L <br /> F Pnnled/Typed Name Signature <br /> R �� f l7.' �� / ' � ', '`T /s�'•� /� Miondi O r Year <br /> AF 3 <br /> S 17n <br /> PPrinted/ryped Name Signature <br /> O , <br /> E1 <br /> T Month &.a <br /> Year <br /> R r Gtl <br /> 18 Discrepancy indication pace V <br /> FA _ <br /> a _ <br /> Printedlfyped Name Slgrre <br /> Man& Day Yea. <br /> WHITE—ORIGINAL(R4vtum to Gwwrato, YELow—TSDF(Ft Copy) PINKK i-TRANSPORTER COPY GOLDENROD—GENERATOR'S COPY <br />