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NOS"-HAZARDOUS WASTE MA EST <br /> NON-HAZARDOUS T---nerator's US EPA fl)No.No. Manifest 7 2.Page 1 <br /> WASTE MANIFEST Document No. NH 6 ( Q (� 1 <br /> (23�75 <br /> nerator's Name and Mailing Address v �! of <br /> t wcy ��nerator's Phone <br /> ansporter 1 Company Name 6. US EPA ID Number A.State Transporter's ID <br /> EVERGREEN ENVIRONMENTAL SERVICES 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 /> 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 1 510 795-4400 <br /> 11.WASTE DESCRIPTION 12.Containers 13. 14. <br /> Total Unit <br /> I I a. No. Type Quantity Wt.Nol. <br /> Non-Hazardous waste, liquid <br /> G b 001 TT 17 Os G <br /> E <br /> N <br /> E <br /> R e. <br /> A <br /> T <br /> O <br /> R d. <br /> W <br /> H <br /> G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> 16.1 <br /> Q <br /> Q15.Special Handling Instructions and Additional Information <br /> _ Invoice: <br /> Z' Profile# Sales Order: w ops 2 2,O y S O <br /> O Do not ingest <br /> Z Wear protective clothing <br /> In case of emergency call: CHEMTREC 800-424-9300 <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 /> Prin yped Name Sig Month Day Year <br /> - j r D C� <br /> TR 17. ransporter 1 Acknowledgement of Receipt of Materials Date <br /> A Printed/Typed Name Signatur Month Day Year <br /> P <br /> R 18.Transporter 2 Acknowledgement of Receipt of Materials Date <br /> T Printed/Typed Name Signature <br /> E Month Day Year <br /> R <br /> 19.Discrepancy Indication Space <br /> C <br /> 1 <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 /> I <br /> Date <br /> Printed/Typed g <br /> /N�me Signature Mot Day Year <br />