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U <br />W <br />I— <br />Q <br />`ION -HAZARDOUS WASTE "MIFEST <br />EES19 <br />15. Special Handling Instructions and Additional Information <br />Profile # n `^,) <br />Do not ingest <br />Wear protective clothing <br />In case of emergency call: CHEMTREC 800-424-9300 <br />DOT ERG 171 <br />Invoice: ?aJ77 <br />Sales Order: uti� <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 />NON -HAZARDOUS <br />1. Generator's <br />US EPA ID No. <br />Manifest <br />2. Page 1 <br />WASTE MANIFEST <br />Z;0 ke <br />Document No. NH 3360 <br />' <br />Date <br />APrinted/Typed <br />Name Si lure <br />Month <br />of <br />N <br />3. Generator's Name and Mailing Address <br />S 1/ell <br />S' Cnv+GG i"1*11 5JTCMJ <br />0 <br />GGtA <br />A -0J- <br />Gni r GZ�..,. .¢ s r <br />DOW <br />R <br />Tr" Co- ITT) > SA v J'�rr Gt <br />Signature <br />Month <br />s'nic <br />E <br />4. Generator's Phone ( ) <br />R <br />5. Transporter 1 Company Name <br />6. US EPA ID Number <br />A. State Transporters ID <br />EVERGREEN ENVIRONMENTAL SERVICES <br />I CAD982413262 <br />B. Transporter 1 Phone 510 795-4400 <br />7. Transporter 2 Company Name <br />8. US EPA ID Number <br />C. State Transporter's ID <br />D. Transporter 2 Phone <br />9. Designated Facility Name and Site Address <br />10. US EPA ID Number <br />E. State Facciilliitys ID <br />EVERGREEN OIL, INC. <br />F. Facility's Phone <br />6880 Smith Avenue <br />Newark, CA 94560 <br />1 CAD980887418 <br />510 795-4400 <br />11. WASTE DESCRIPTION <br />12. Containers <br />13. <br />14. <br />Total <br />LIN <br />No. <br />Type <br />Quantity <br />Wt.fv <br />a. <br />Non -Hazardous waste, liquid <br />001 <br />TT <br />U <br />G <br />G <br />b. <br />E <br />N <br />E <br />R <br />c. <br />A <br />T <br />O <br />R <br />d. <br />G. Additional Descriptions for Materials Listed Above <br />H. Handliinng1Codes for Wastes Listed Above <br />l�` J <br />15. Special Handling Instructions and Additional Information <br />Profile # n `^,) <br />Do not ingest <br />Wear protective clothing <br />In case of emergency call: CHEMTREC 800-424-9300 <br />DOT ERG 171 <br />Invoice: ?aJ77 <br />Sales Order: uti� <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 />A' <br />C <br />20. Facility Owner or <br />T Printedlfyd Name <br />Y 1 A. i <br />G <br />receipt of the waste materials covered by this manifest, except as noted initer 19,. <br />/1 /�J <br />Day <br />Printedlryped Name <br />t re <br />Month <br />Day <br />Z;0 ke <br />T <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />Date <br />APrinted/Typed <br />Name Si lure <br />Month <br />Da Y <br />N <br />� <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />DOW <br />R <br />Printed,,Typed Name <br />Signature <br />Month <br />Day <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A' <br />C <br />20. Facility Owner or <br />T Printedlfyd Name <br />Y 1 A. i <br />G <br />receipt of the waste materials covered by this manifest, except as noted initer 19,. <br />/1 /�J <br />Day <br />