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NOP11-HAZARDOUS WASTE MAN'PEST <br /> EES19 <br /> NON-HAZARDOUS 1.venerators US EPA ID No. Manifest 2.Page 1 <br /> WASTE MANIFEST Document No: NH 5303 <br /> of 1 <br /> 3CC,engrator'uafm�nd im ddress <br /> Z3��5 G� IIRVV U�i�+3 <br /> 4.Generator's Phone( ) <br /> 5.Transporter 1 Company Name 6. US EPA ID Number <br /> I A.State Transporter's ID <br /> EVERGREEN ENVIRONMENTAL SERVICES I CAD982413262 B.Transporter 1 Phone 510 795-4400 <br /> 7.Transporter 2 Company Name 8. US EPA ID Number <br /> I C.State Transporter's ID <br /> D.Transporter Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> 'EVERGREEN OIL, INC. F.Facility's Phone <br /> 6880 Smith Avenue <br /> I Newark, CA 94560 CAD980887418 510 795-4400 <br /> 11.WASTE DESCRIPTION 12.Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity Wt.Nol. <br /> Non-Hazardous waste, liquid <br /> 001 TT I � �� 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 /> G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> U) <br /> D <br /> C) <br /> 0 <br /> Q <br /> N 15.Special Handling Instructions and Additional Information / <br /> _ Invoice: - qob—17 <br /> 3 <br /> Z Profile# Sales Order: <br /> 0 Do not ingest 7� <br /> Z Wear protective clothing <br /> In case of emergency call: CHEMTREC 800-424-9300 <br /> DOT ERG 171 <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 /> I n 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 Da Y ar <br /> '/RU DitviDE2UI,AL-VA J h <br /> TR 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> NPrinted/Typed Name Signature Month Day Year <br /> P6�4G �a 'II II &B <br /> O 18.Transporter 2 Acknowledgement of Receipt of erials Date <br /> TPrinted/Typed Name Signature Month Day Year <br /> E <br /> R <br /> F 19.Discrepancy Indication Space <br /> . .L l <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 Printedrryped Name Signature <br /> Y M/�o I . h D/a�y qY <br /> V (f <br />