Laserfiche WebLink
G <br />E <br />N <br />E <br />R <br />A <br />T <br />O <br />R <br />W <br />1— <br />U) <br />O <br />0 <br />a <br />N <br />Q <br />Z <br />O <br />Z <br />NCJJ- HAZARD�US WASTE MAV( - EST <br />FFS14 <br />—NONHAZARDOUS <br />WASTE MANIFEST <br />1.�enerators US EPA ID <br />Manifest <br />Document No. N{ <br />' 1 <br />�s y <br />'+ C <br />2 Page 1 <br />of 1 <br />3. Generator's Name and Mailing Address <br />I <br />4. Generators Phone ) <br />S <br />P <br />Q <br />18. Transporter 2 Acknowledgement of Receipt of Materials Date <br />5. Transporter 1 Company Name 6. <br />EVERGREEN ENVIRONMENTAL SERVICES I <br />US EPA ID Number <br />CAD982413262 <br />Signature Month Day Year <br />A. State Transporter's ID <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 />F <br />D. Transporter 2 Phone <br />A <br />9. Designated Facility Name and Site Address 10. <br />EVERGREEN OIL, INC. <br />6880 Smith Avenue <br />Newark, CA 94560 <br />US EPA ID Number <br />CAD980887418 <br />E. State Facility's ID <br />20. Facility Owner or Operator: Certification of receipt of the waste materials co ered by this manifest, except as noted in item 19. <br />F. Facility's Phone <br />1 510 795-4400 <br />11. WASTE DESCRIPTION <br />Date <br />12. Containers <br />No. I Type <br />Name <br />13. <br />Total <br />Quantity <br />14. <br />Unit <br />Wt./Vol. <br />I a. <br />Non -Hazardous waste, liquid ` <br />001 <br />TT <br />�� ° <br />G <br />b. <br />C. <br />d. <br />i <br />G. Additional Descriptions for Materials Listed Above <br />H. Handling Codes for Wastes Listed Above <br />15. Special Handling instructions ana Aaaibonai lntormatlon <br />Profile # <br />Do not ingest <br />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 #hipm <br />in proper condition for transport. The materials described on this manifest a not <br />Invoice: <br />Sales Order: <br />fully and accurately described and are in all respects <br />to federal hazardous waste regulations. <br />Date <br />Pnnted/Typed Name <br />Signature - Month Day Year <br />T <br />17. Transporter 1 Acknowledgement of Receipt of Materials Date <br />APrinted/Typed <br />Name Signature Month Day Year <br />S <br />P <br />Q <br />18. Transporter 2 Acknowledgement of Receipt of Materials Date <br />R <br />T <br />Printed/Typed Name <br />Signature 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 co ered by this manifest, except as noted in item 19. <br />L <br />Date <br />TPrinted/Typed <br />Name <br />Signature Month Day Year <br />Y <br />