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NON-HAZARDOUS WASTE MAN'FEST <br /> EES19 <br /> NON-HAZARDOUS 1. aerator's US EPA ID No. DManifest <br /> ocument No. NH /� 8 n A 2.Page 1 <br /> WASTE MANIFEST \fl �} a (� of 1 <br /> 3.Generator's Name and Mailing Address <br /> 16R��t;i� SNCL <br /> Z 3�� <br /> 6—a-1VV-LJ A)C t2D <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 /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> C&)L? �7W <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 /> No. Type Quantity Wt.Nol. <br /> I <br /> I a. <br /> Non-Hazardous waste, liquid 13 <br /> 001 TT 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 /> H <br /> I <br /> I G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> 7 _ <br /> C <br /> 0 <br /> a <br /> N 15.Special Handling Instructions and Additional Information (A� <br /> _ Invoice: <br /> Z' Profile# � Sales Order: <br /> Do not ingest <br /> O <br /> Z Wear protective clothing <br /> In case of emergency call: CHEMTREC 800-424-9300 <br /> DOT ERG 171 r e ✓ron d �� �l 1 <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 /> KU <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> A Printed/Typed Name I Signature Month Day Year <br /> "s C � 1n,, v1 Lam- i Z lv <br /> P <br /> Q 18.Transporter 2 Acknowledgement of Receipt of aterials Date <br /> RPrinted/Typed Name Signature Month Day Year <br /> E <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 Pri d/Typed Name Signature Mo th ay Year <br />