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NON-HAZARDOUS WASTE MANIFEST <br /> EES19 <br /> NON-HAZARDOUS 1.u�nerator's US EPA ID No. Manifest Document No. NH 4663 2 Page 1 <br /> WASTE MANIFEST of 1 <br /> 3.Generator's Name and Mailing Address <br /> C1 33 7 <br /> 4.Generator' 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 /> I <br /> 'EVERGREEN OIL, INC. F.Facility's Phone <br /> 6880 Smith Avenue <br /> Newark, CA 94560 CAD980887418 12 Containers <br /> 795-4400 13. 14. <br /> 111.WASTE DESCRIPTION Total Unit <br /> No. Type Quantity Wt./Vol. <br /> I <br /> Ia. <br /> Non-Hazardous waste, liquid ! <br /> 001 TT G <br /> G h. <br /> E <br /> N <br /> E <br /> R e. <br /> A <br /> T <br /> O <br /> R d. <br /> W <br /> H <br /> N , <br /> I G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> N 15.Special Handling Instructions and Additional Information <br /> Q Invoice: <br /> ZI <br /> Profile# Sales Order: 12- <br /> Do not ingest <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 /> 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 /> T 17.Transporter 1 Acknowledgement of Receipt of Materials �^ Date <br /> R <br /> A Printed/Typed Name Signat�ra t' Month Day Year <br /> f ! _ <br /> N i (s G <br /> Q18,Transporter 2 Acknowledgement of Receipf of Materials 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 /> I Date <br /> 'T' Printed/Typed Name Signature Month Day Year <br /> Y <br />