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t Generator's US EPA 1D No FPago 3 Doairnent Number <br /> NH-N° 1 400 <br /> 4 Gene s Name and Mailing Address EES 19 <br /> A <br /> Generator s Phone <br /> 5 Transporter Company Name 6 US EPA ID Number 7 Transporter Phone <br /> EVERGREEN ENVIRONMENTAL SERVICES <br /> CAD982413262 800-972-5284 <br /> 8 Designated Facility Name and Site Address 9 US EPA ID Number 10 Factlrty's Phone <br /> Evergreen Oil, Inc <br /> 6880 Smith Avenue <br /> G Newark, CA 94560 CAD980887418 510-795-4401 <br /> 13 <br /> E 11 Waste Shipping Name and Description 12 Conta+ners of* 14 <br /> N No T Total <br /> wwol <br /> E <br /> R $ <br /> A - azardous waste, Ii uid <br /> 001 TT <br /> T <br /> o ater n oil <br /> R b <br /> 15 Spoaal Handling Instructions and Additional Information Handling Codes for Wastes Usted Above <br /> ti 11b <br /> Profile# <br /> Do not ingest <br /> Wear protective clothing Invoice <br /> In case of emergency tail CHEMTREC 800-424-9300 Sales Order <br /> DOT ERG 171 <br /> cJ �oG4T.'a�_ <br /> 16 G&FAATDRrS CERTMA1T s J_�� - D�al rdous YJaste <br /> pnnted/Typed Name <br /> Signature <br /> R �� ��� _ / Month Day Y",N 'tea <br /> S 17 T <br /> PO Printed typed Name Signature <br /> R 'nth Day Year <br /> 18 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> Y,i <br /> Mai '— <br /> Printed/ryped No 7Copy) <br /> Month Day Yaa, <br /> lie l 1, <br /> WHITE—ORIGINAL(Return to Generator) -YELLOW—TSOF(RI --TRANSPORTER COPY GOLDENROD—GENERATOR'S COP <br />