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Generator's US TEPA ID No. 2.Page 1 3.Document Number <br /> of <br /> NH- <br /> 4.Coe orator's Name an. <br /> dMaiillng Atferess EES 19 <br /> i Generator's Phone ,G , U'0.° 4; <br /> 1 <br /> S.Transporter Company Name B. US EPA ID Number 7.Transporter Phone <br /> p EVERGREEN ENVIRONMENTAL SERVICES <br /> CA0982413262 800-972-5284 <br /> S.Designated Facility Name and Site Address 9. US EPA ID 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 /> No. s Qua! Unit <br /> e <br /> Non-Hazardous waste, liquid <br /> Water and oil 001 7r G- <br /> b s <br /> 15.Special Handling Instructions and Additional Information Handling Codes for Wastes listed Above <br /> Ila. 11t3. <br /> Profile; <br /> Do not'ingest <br /> Wear protective clothing Invoice: {o7 _5 jf <br /> In case of emergency call: CHEMTREC 800-424-9300 Sales Order: <br /> - .BOT ERG 171 <br /> g Printefffyped Name Signature w <br /> 'ray... �,.����t r+.vr.+ ��Yt /ir 55�^c.•.�,.=+ <br /> f f Month Day Year <br /> PdntedRyped Name Signature <br /> • t <br /> Month Day Year <br /> ' 18.Discrepancy I ication Space <br /> i <br /> Printedrryped Name Signature <br /> 9 <br /> Month Day Year <br /> ' WHITE—ORIGINAL(Return to Generator) YELLOW—TSDF(Retain Copy) PINK—TRANSPORTER COPY GOLDENROD—GENERATOR'S COPY <br /> ,� <br />