Laserfiche WebLink
NICU-1 —2004 14:02 GREEN OIL INC 5113 608 0183 P.02 <br /> Writ Approved OAAA Na.2054-0079(Expires 930 94( See Instructions on back of C 6. bes arrm■m of Toxic Substances Control <br /> Phase print ar type. form desigrrecf for we on este f 12-ja kh) rile,. Socrgmenta,Colifamia <br /> UNIFORM HAZARDOUS 1. Generator's US EPA 0No. Manifest Document No. 2. Page 1 Information in the shaded apps <br /> WASTE MANIFEST p 101q0D t O 4 of 1 is not required by federal iar. <br /> EES4 <br /> 3. Gan* <br /> an rotor's No" d ails ( { w, Slag ftlai!rfl Qaevi�uni Nute6u <br /> e r 3�, 7b �ra>y s7 2 9 4(3 <br /> 5r. <br /> 57beA"t yt1/ 449:5-to + a Slat$Cren9ralgr r l4 v ;s <br /> u"s 1. Genarntar s Phone i <br /> tN S. Transporter 1 Company Name a. US SPA!b Number ._ <br /> EVERGREEN ENVIRONMENTAL SERVICES <br /> CADs82a13aez ,°,+ 'r �f7rs : <br /> 7. Transporter 2 Campgny Nome S. U$EPA Ib Number in, J, <br /> Vit A' A <br /> 9, DestonattodyFarifiryr�Name and Site Addra" 10, US EPA 1D Numbw C++ N i �, ' r <br /> f1lllRGREEN Ol�INC. „ y'fr <br /> # 'l <br /> n p 6880 Smith Avenue t{, Fae61i'Fy�'"j6- <br /> 66 <br /> tllttw Newark CA 94560A I) 9 $101818171411 $ " "` 0�7 •r; ,; <br /> 12. Containers 13, Total 14. Unit <br /> I I. ub DOT Drseripiioe(inelediaa Praper Shipping Name,Hazard Class,and Ib Number) <br /> l f r,1 ( No. Type QuantityWt/Ya( I Mtwb Nuitiletr , <br /> c NON•RCRA HAZARDOUS WASTE,LIQUfD e*,r et.r <br /> O 0 1 T' Viol U G Datta. <br /> o N 6" swf. <br /> oma E ,. <br /> T stere r <br /> co O <br /> REliAloikor <br /> ,W. d. State <br /> u r EPAl*er <br /> V <br /> w <br /> z1.,AdditionaF'Detcripiiont.lpr.Abt�,oalt tattrri Above K °ttandling Codes far Wallet Listed Above <br /> O0. <br /> LO <br /> �. <br /> ut <br /> d <br /> Z 15. Special Handling Instructions and Additional Inlarmokoo <br /> 24 Hour Emergency Response Telephone No.:CHEMTREC 1-900424-9300 Invoice E Zr <br /> W <br /> DoT ERG 171 WEAR PROTECTIVE EQtf P MENT Sales Order#T' rs 7`qJ 1 <br /> IE <br /> 16° GENERATOR'S CtInFICAVON' I hereby declare that the convents of this cans�gnment ore fully and a<curalnl doscri6ed o6ore 6y proper shipping aamo and are classified,pcl4od, <br /> marked,and la6alad,and are in all respects in prgpar candihon for Ortsnsp "by highway according Fa applicable�nternaticnol and naiionol aaycrnment regulolianr. <br /> lF I ern a large qutinliy ganeralor,I certify that I bore a pr rom in place to rads{a the valume and Iox'idty of waste psneroted sa the degree 1 have determined to be economically <br /> CL. practicable and that I haw selected the practicable mathod of tnatmeni,storage,or dhposal cwrently availabla to me which minimizes the preterit and fours threal to human heaU <br /> u7 and the environment;OR,iF l am a smug quartlity"reratnr,I have made a good larch effort to minimize my wasia ganaeotion and telco the best woste management method Ihal is <br /> oe avoilnWis to me and shot I can afford, ' <br /> O <br /> } Printed/Typod Nam. Sdgnar Monih Day Year <br /> z -#rr 4f?'9440-' ,� Z) C 0 <br /> w 1 —•- <br /> (} j 17, Trans aryl I Acknowledgement a{ROCQI t of Mplerialt <br /> nt <br /> 1 Printed/ d Name $1 not Month PaY Y.as <br /> Lu <br /> 9 a NR- t <br /> w- b 18. Tr t flet 2 Ac ngwled ement of Recei t aF Molerials _ <br /> 0 k Prinred/Typed Name Signgsure Month Day Year <br /> 1 <br /> uJ E <br /> +n � <br /> lj l9. Discrepancy IndicAtion Span <br /> A <br /> C <br /> L <br /> I 20. ocitloy Owner or Optirator Corlificatioo of rteeiel of hozordqus mplerials covered by this monifett except as noted In Item 34. .� <br /> T Print ped Nome Signatur Month Day Your <br /> Y <br /> Q <br /> DO NOT WRITE BELOW`THIS NE. <br /> DTSWh.ra' TSDF SENDS THIS COPY TO DT5C WFTHIN 30 DAYS, <br /> EPA 87000---22 8011`/99{ Ta: P.O. Bon 3000, Sacramento, CA 96812 <br /> EPA <br />