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NON-HAZARDOUS WX,TE MANIFEST <br /> EES19 <br /> NON-HAZARDOUS <br /> T-­,.rato,'s US EPA ID No. Document No. NH 4 3 6 2 Manifest 2 Page 1 <br /> WASTE MANIFEST of 1 <br /> 3.Generator's Name and Mailing Address 3'G jtN J3. 674 wi <br /> 6-T,,41-r L r A.e J'Ile, <br /> i .37 J- L,./. (rv^A^,J Lr .c C{L �6 YS S.A/rr;srr� 4��f y <br /> ;„may 4 ?.r_777 c4s7-ra VOP-11 4 <br /> 4.Generator's Phone( 1_/0 ) r• / 9 yryb <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 /> '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 a. <br /> Non-Hazardous waste, liquid <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 /> F— <br /> 1 G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> 0 <br /> 0 <br /> Q <br /> Q15.Special Handling Instructions and Additional Information <br /> _ Invoice:2d1/t/72 <br /> r <br /> Z Profile# Sales Orderw ;J- <br /> Do not ingest <br /> O <br /> Z Wear"ase <br /> rotective clothing <br /> mergency call: CHEMTREC 800-424-9300 <br /> 71 <br /> FA <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 /> Print y ame Signature � Month Day Year <br /> -FEC <br /> LIA <br /> (�_-- / ISO a? <br /> T `+DfMatei`ias�+r}.� <br /> R <br /> A Printed/T <br /> a!5_Name Signature Month Day Year <br /> P <br /> 0f3 E> i r elr�ipt of tiAaferjd�S 'd Date `x:s <br /> T Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> F 19.Discrepancy Indication Space <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 Month Day Year <br /> Y ,��S U17� d f a e <br />