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GenaP$ta SPR W'No; 2.Page 1 3.Document Number <br /> of <br /> ' 4.Gem rs aili els r EES 19 <br /> I 0.Z Ij K0rJC0'0qh4M DA. 5,4H6 IN <br /> Generator's Phone A. <br /> 5.Transporter Company Name B. 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.Facility's Phone <br /> Evergreen Oil, Inc. <br /> 6880 Smith Apnue <br /> Newark, CAx`560 CAD980887418 510-795-4401 <br /> 111.waste ShippI4'game and Description 12.Containers 13. 14. <br /> nit <br /> No. T Quantic WUV01 <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 /> ' Profile# <br /> Do not ingest <br /> Wear protective clothing Invoice: 6 70 44-2 <br /> -2 <br /> In case of emergency call: CHIEMTREC 800-424-9300 Sales Order: <br /> DOT ERG 171 <br /> • s @ <br /> �gi�IJG'++sa, <br /> Printeped Name �.- m , �• „.�. . <br /> w Sf®nature <br /> �.� .. Q T• ... i C . :� _ r r i� T� _.. !� ;1 Mu, Day Year <br /> Printe& yped Name Signature <br /> Month Day Maar <br /> ,ko PO 4 , <br /> ' 18.Discrepancy Indication Space <br /> Prin[adI(yped Name 61,g nature <br /> Month .Day Year <br /> WHITE—ORIGINAL(Returnto Generator) YELLOW--TSDF(Retain Copy) PINK—TRANSPORTER COPY _ GOLDENROD—G WE COPY <br /> e <br />