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NO11' 'HAZARDOUS WASTE MA ST <br /> NON-HAZARDOUS 1.Venerators US EPA ID No. Manifest �� EES19 2.Page 1 <br /> WASTE MANIFEST Document No. 6 <br /> of <br /> I i 3.Generator's Name and Mailing Address <br /> C-4*60 L t A Q -,;)%&L A <br /> APe.J <br /> 4.Generator's Phone <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.State Transporter's ID <br /> I <br /> EVERGREEN ENVIRONMENTAL SERVICES I CAD982413262 B.Transporter 1 Phone 510 795-4400 <br /> 7.Transporter 2 Company Name 8. US EPA ID Number C.State Transporter's ID <br /> I _ <br /> I D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> I <br /> 'EVERGREEN OIL, INC. F.Facility's Phone <br /> 6880 Smith Avenue <br /> Newark, CA 94560 CAD980887418 510 795-4400 <br /> 11.WASTE DESCRIPTION 12.Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity Wt./Vol.l la <br /> Non-Hazardous waste, liquid <br /> 001 TT r 7 �� G <br /> G b. <br /> E <br /> N <br /> E <br /> R c. <br /> A <br /> T <br /> O <br /> R d. <br /> W <br /> I-- <br /> N , <br /> G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> O <br /> 0 <br /> cr. <br /> 1 <br /> N 15.Special Handling Instructions and Additional Information <br /> 2 I Invoice: <br /> Profile# Sales Order: G 2 z D -Li <br /> Z S C� <br /> Z Do not ingest <br /> Z Wear protective clothing <br /> In case of emergency call: CHEMTREC 800-424-9300 <br /> AV <br /> WAFAWAFAW <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 materials described on this manifest are not subject to federal hazardous waste regulations. <br /> Date <br /> Printed/Typed Name Signature Month Day Year <br /> f. <br /> T 17.Transporter 1.Acknowledgement of Receipt of Materials <br /> RPrinted/T ed Nnatu <br /> A Printed/Typed Name Si 9 / Month Day Ye r <br /> P <br /> O 18.Transporter 2 Acknowledgement of Receipt of Materials Date <br /> ERPrinted/Typed Name Signature <br /> Month Day Year <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> 20.Facility Owner or Operator.Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> L <br /> Date <br /> T Printed/Typed Name Signature <br /> Y Month Day Year <br />