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A y ♦ _ <br /> s 1 Generator's US EPA ID No 2 Page 1 3 Document Number <br /> Lvao <br /> Not � �� U t °` NH-NQ 1236 <br /> EES 19 <br /> 4 Generator's Name and Mailing Address <br /> Se�rU ��-� N11)� /Csa, <br /> a Generator's Ptr A(jj ko —5;tn woo&k y,�m L (:f+ li5 <br /> 5 Transporter Company Name B US EPA ID Number 7 Transporter Phone <br /> EVERGREEN ENVIRONMENTAL SERVICES <br /> CAD982413262 800-972-5284 <br /> a Designated Facility Name and She Address 9 US EPA ID Number 10 FedlWe Phone <br /> Evergreen Oil, Inc <br /> 6880 Smith Avenue <br /> G Newark, CA 94564 CAD980887418 510-795x4401 <br /> 12 Containero <br /> E t, Waste Shipping Name and Description TO 81 Unit <br /> N No T <br /> QuanIfty WWol <br /> R a <br /> T Non-Hazardous waste, liquid <br /> 001 TT Z..00 G <br /> o Water and od <br /> R b <br /> is Special Handling Instructions and Addibonal Information l,p a+14 +Q/V Handling Codes for Wastes Listed Above <br /> A vac. t LtD+ " „a 1,b <br /> Profile# rZI <br /> itAvc� <br /> Do not ingest 9+oC '4-6 ' <br /> 7c)(6%q <br /> Wear protective clothing Invoice ' (p-7 <br /> In case of emergency call CHEMTREC 800-424-9300 Sales Order <br /> DOT ERG 171 <br /> 16 GENFAATOR'8t �� ;rie <br /> ntedrryped Name Signature <br /> Month Day Year <br /> S 17 T _ <br /> PO PnntedrTyped Name Signature <br /> Efjl" V� r / March Day Year <br /> 18 Discrepancy Inds tion Space v <br /> F <br /> A <br /> C <br /> I <br /> t <br /> Printedinyped Name Sigtsature <br /> MWNt Day Year <br /> WHITE—ORIGINAL(Return to Gemralor) YELLOW—TSDF(Retain Copy) PINK—TRANSPORTER COPY GOLDENROD_0ENERATOR'S COPY <br />