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NON-HAZARDOUS WASTE MANIFEST <br /> EES19 <br /> NON-HAZARDOUS <br /> T. ,erator's US EPA ID No. Document No. 2.Page 1 <br /> WASTE MANIFEST NH 4362 of 1 <br /> 13.Generator's Name and Mailing Address �u+l+ 13. Td w/f-d.0 <br /> 3-7r w. c- ,^ , r . --e <br /> n._ C-/ 4S"377 ;�.> ecu V,))/et4 L4 <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 /> I <br /> D.Transporter 2 Phone <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number E.State Facilitys ID <br /> I <br /> 'EVERGREEN OIL, INC. F.Facility's Phone <br /> 6880 Smith Avenue <br /> Newark, CA 94560 CAD980887418 510 795-4400 <br /> 11.WASTE DESCRIPTION 12.Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity Wt./Vol. <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 /> I— <br /> N , <br /> G.Additional Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> Cn <br /> D <br /> O <br /> 0 <br /> Q � I <br /> N 15.Special Handling Instructions and Additional Information <br /> OF <br /> Z Profile# Sales Order:` <br /> O 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 /> Print ype d Name Signature Month Day Year <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials Date <br /> APrintedlTyped Name Signature Month Day Year <br /> P , <br /> O 18.Transporter 2 Ackriowledgement of Receipt of Materials Date <br /> RPrinted/Typed Name Signature <br /> T 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 Printedrryped Name Signature <br /> Month Day Year <br /> Y <br />