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-HAZARDOUS WASTE MAN ST <br /> Please print or type (Form designed for use on elfte(12 pitch)typewriter) <br /> NON-HAZARDOUS1.C-e�nA�to l� S71 Manifest 2.Page 1, <br /> WASTE E MANTES 1TS Document No. <br /> Of <br /> 3.RgdWrQhWItnd Mailing Address <br /> APN 17517018, 17517019& 17519001 <br /> Stockton, CA 95206 <br /> 4.Generator's Phone(916 8?6-1553 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.State Transporter's ID 3544 <br /> Fremouw Environmental Services, Inc. CAR000171017 B.Transporter 1 Phone 53U-19b-4331 <br /> 7.Transporter 2 Company Name 8. US EPA ID Number C.State Transporter's ID <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> Evergreen Oil, Inc. CAD980887418 <br /> 6880 Smith Avenue F.Facility's Phone <br /> Newark, CA 94560 510-795-4400 <br /> 11.WASTE DESCRIPTION 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity WLNol. <br /> a. <br /> ^; r <br /> Non-Hazardous Waste, Liquid (Waste Water) TT - <br /> G b. <br /> E <br /> N <br /> E <br /> R c. <br /> A <br /> T <br /> d. <br /> W R <br /> aG.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> a <br /> Q15.Special Handling Instructions and Additional Information <br /> = HANDLERS TO BE 40 HR TRAINED AND WEAR PPE <br /> e <br /> Z <br /> Z <br /> AMM AMW <br /> Am Am AIE ARM AIE Air AIE AIE AIF my Am M IN= <br /> 16.GENERATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are in all respects <br /> in proper condition for transport.The matenals described on this manifest are not subject to federal hazardous waste regulations. <br /> Date <br /> Printed/Typed Name Signature Month Day ,Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> R <br /> A. Printed/Typed Name Signature Month Day Year <br /> N <br /> P <br /> 0 18.Transporter 2 Acknowledgement of Receipt of Materials Date <br /> R <br /> T Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> Ci <br /> 1 20.Facility Owner or Operator;Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> I Date <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> F-1402002 LABE ® ®(800)621-5808 WWWJabelrnaste,com AMPRINTED CM RECYCLED PAPER vn xr[o mix Rev.3/95 <br />