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' <br /> Generators US EPA ID No 2' Page 1 3 Document Number <br /> ARO <br /> -NON-I-�AZ�Qo, <br /> =4WASTEMANiF 1 NH— i . 1382 <br /> 4 Generators Name and Marling Address EES 19 <br /> i <br /> Generators 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 Facility s Phone <br /> r� <br /> Evergreen Oil, Inc <br /> 6880 Smith Avenue <br /> G Newark, CA 94560 CAD980887418 510-795-4401 <br /> E 11 Waste Shipping Aping Name and Description 12 Containers 13 14 <br /> na <br /> E No Type Qua tl wvvol <br /> R a <br /> Y Non-Hazardous waste, liquid �- <br /> A Water and oil 001 TT- J G <br /> b <br /> IS Special Handling Instructions and Additional Information Handling Codes for Wastes Listed Above <br /> Ila 11b <br /> Profile# <br /> Do not ingest <br /> Wear protective Clothing Invoice <br /> In case of emergency call CHENITREC 800-424-9300 Sales Order <br /> DOT ERG 171 Lf <br /> 1 S GENERATOR'S CEiMiidA-idkt ['ca* "�a er "reQtil`atloas tat t poi n`°Q pro eittlrsposal olyia�irdo"us waste's <br /> Printedrryped Name Signature <br /> R <br /> Mc <br /> Day Year <br /> A �� e�11 t,t /�1�1 '�' //f �' ~; '`ter✓ FI• 7 `? <br /> $ 17 Trans'Pat <br /> OPnntedrryped Name Signature <br /> R II L ( (4 t <br /> RE !J f- �� fi f !�C I ` `� �.% �.-�C I i 1 k L ; _ ra i_C Month Day Year <br /> 18 Discrepancy Indication Space <br /> —H <br /> s X <br /> r <br /> F, <br /> A <br /> C <br /> PdntedrTyW Name Signature <br /> Month Day Year <br /> WHITE—ORIGINAL(Return to Generator) YELLOW—TSDF(Retain Copy) PINK—TRANSPORTER COPY GOLDENROD--GENERATOR'S COPY <br />