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NON-HAZARDOUS >&F 4 Generator s US EPA ID No 2 Page 1 3 Document Number <br /> of <br /> WASTE MANIFEST 1 <br /> NH-N-, 1313 <br /> 4 Generator's Name and Mailing Address EES 19 <br /> r^rra, � a-GC.- <br /> Generator s Phone c-J • �/r p p <br /> 5 Transporter Company Name a US EPA ID Number 7 Transporter Phone <br /> EVERGREEN ENVIRONMENTAL SERVICES <br /> CAD982413262 800-972-5284 <br /> 8 Designated Facility Name and Site Address 9 US EPA ID Number 16 Facility's Phone <br /> Evergreen Oil, Inc <br /> 6880 Smith Avenue I <br /> G Newark, CA 94560 CAD980887418 510-795-4401 <br /> E 14 <br /> 11 Waste Shipping Name and Description 12 Containers T13 ota! <br /> it <br /> E No Type Quan WWoI <br /> Ra <br /> A <br /> Non-Hazard�'�uaste, liquid <br /> a Waterlan-d oil 001 TT �� 3 �� G <br /> R b <br /> 15 Special Handling Instructions and Additional Information Handling Codes for Wastes Listed Above <br /> 11a 11b <br /> Profile# <br /> Do not ingest <br /> Wear protective clothing Invoice 7/J-O Z 3 <br /> In case of emergency call CHEMTREC 800-424-9300 Sales Order <br /> DOT ERG 171 <br /> 18 GENERATOR'S CERTIFICATION I certify the materials descrlfied above oe lhis manifest afd not subjW to state iiifederalllivii Fairs for 45-rer p proper disposal ot,Harard6us Waste <br /> IF Pnntedrryped Name Signature <br /> RTMonth Day Year <br /> A Am-rkiaj Scan ,�cr 04 �u 98 <br /> $ 17 Transporter Acknowledgement of Receipt of Materials <br /> P <br /> O Printed/Typed Name Signature <br /> R <br /> Month Day Year <br /> 18 Discrepancy Indication Space <br /> F <br /> A, <br /> C <br /> i <br /> L <br /> 1 <br /> .,19 FaciiltjOwner or Operator certitication of receipt,f Waste matertala 0iieted bythitftOW -bs tt<5tedfi Its" 8; <br /> Pnntedrryped Name Signature <br /> T <br /> Month Day Year <br /> WHITE—ORIGINAL(Return to Generator) YELLOW—TSDTr(Retain Copy) PINK—TRANSPORTER COPY GOLDENROD—GENERATOR S COPY <br />