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NON -14 "ZARDOUS WASTE MANIF%T <br />FFR14 <br />NON -HAZARDOUS <br />1. Genera..,, s US EPA ID No. <br />M i est <br />2. Page 1 <br />Document No. NH <br />4300 <br />WASTE MANIFEST <br />Of <br />i <br />3. Generator's Name and Mailing Address <br />I <br />4. Generator's Phone <br />5. Transporter 1 Company Name 6. <br />US EPA ID Number <br />A. State Transporter's ID <br />EVERGREEN ENVIRONMENTAL SERVICES I <br />CAD982413262 <br />B. Transporter 1 Phone <br />510 795-4400 <br />7. Transporter 2 Company Name 8, <br />US EPA ID Number <br />C. State Transporter's ID <br />D. Transporter 2 Phone <br />9. Designated Facility Name and Site Address 10. <br />US EPA ID Number <br />E. State Facility's ID <br />'EVERGREEN <br />OIL, INC. <br />F. Facility's Phone <br />6880 Smith Avenue <br />Newark, CA 94560 1 <br />CAD980887418 <br />510 795-4400 <br />111. <br />WASTE DESCRIPTION <br />12. Containers <br />13. <br />14. <br />Total <br />Unit <br />No. Type <br />Quantity <br />Wt./Vol. <br />I <br />a. <br />Non -Hazardous waste, liquid <br />001 <br />17 <br />G <br />j <br />b. <br />v <br />C. <br />4 <br />r <br />d. <br />1 <br />G. Additional Descriptions for Materials Listed Above <br />H. Handling Codes for Wastes Listed Above <br />15. Special Handling Instructions and Additional Information <br />Invoice: <br />Profile # <br />Sales Order: <br />Do not ingest <br />Wear protective clothing <br />In case of emergency call: CHEMTREC 800-424-9300 <br />DOT ERG 171 <br />IN <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 <br />subject to federal hazardous waste regulations. <br />Date <br />Pdnted(Typed Name <br />Signature <br />Month Day Year <br />T <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />Date <br />APrinted/Typed <br />Name <br />Signature <br />Month Day Year <br />N <br />P <br />Q <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />Date <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />:A <br />C <br />1 <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 />TPrinted/Typed <br />Name <br />Signature <br />Month Day Year <br />Y <br />