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•`.¢ Generators US itik 10 No. 2.Page 1 3.Document Number <br /> of 1 � � ,.. <br /> R <br /> Gran �&tRYs Na a and iling A "ss <br /> EES 19 <br /> ' Generator's Phone <br /> S.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 10 Number 10.Facility's Phone <br /> Evergreen Oil, Inc. <br /> 6880 Smith Avenue <br /> Newark, CA 94560 CAD980887418 510-795-4401 <br /> 11.Waste Shipping Name and Description 12.Containers 13. 14. <br /> Total Unit <br /> No. T Quantity wwal <br /> i a. <br /> Non-Hazardous waste, liquid <br /> ' Water and oil 001 TT G <br /> b. <br /> 15.Special Handling Instructions and Additional Information Handling Codes for Wastes Listed Above <br /> ,- 11a. 11b. <br /> s <br /> Profile# <br /> Do not ingest <br /> ' Wear protective clothing Invoice: <br /> In case of emergency call: CHEMTREC 800-424-9300 Sales Order: <br /> DOT ERG 171 <br /> Pdnt�lSyp&l a Signature -- <br /> Month Day Year <br /> A�cx �I�r�,s �. P. Thc•�;,:+> �nS�• ��� �.,_.Cdc.�.a.�e...,,� �'� o'� �g <br /> Printedrtyped Name Signature <br /> ir�� 4 �I oo n <br /> 18.Discrepancy Indication Space ` <br /> +i PrintedrWed Name Signature <br /> t <br /> Manch Day Year <br /> 7 <br /> WHITE—ORIGINAL(Retum to Generator) YELLOW—TSOF(Retain Copy) PINK--TRANSPORTER COPY GOLDENROD—GENERATOR'S COPY <br /> ._ _, - <br />