Laserfiche WebLink
W .-HAZARDOUS WASTE MAN. QST <br /> ' EES19 <br /> 1.Generator's US EPA ID No. Manliest <br /> - WASTE MANIFEST ('.QL2 Page 1 <br /> NON-HAZARDOUS <br /> Document No.GC�� NH 110 4 3 of 1 <br /> 3.GenE ralor's Name and Mailing Address—TT�F:;(_`I t=t t FCL <br /> Ta., 011 C_�A q 53('11 <br /> 4.Gene ator's Phone( 22 Ll — �_C Z <br /> S.Tran rter 1 Company Name 6. US EPA ID Number A.State Transporter's ID <br /> l <br /> EVER 3REEN ENVIRONMENTAL SERVICES I CAD982413262 B.Transporter t Phone 510 795-4400 <br /> 7.Trans rter 2 Company Name 6. US EPA ID Number C.SlateTransporter's ID <br /> I <br /> j D.Transporter 2 Phone <br /> 9.Desic hated Facility Name and Site Address 10. US EPA ID Number E.State Facility's ID <br /> l <br /> 'EVER 3REEN OIL.INC. F Facility's Phone <br /> 6880 mith Avenue <br /> Newa ,CA 94560 CAD980887418 510 795-4400 <br /> 1 L WA TE DESCRIPTION 12.Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity Wt./Vol. <br /> I I a. <br /> Non-Hazardous waste,liquid /� } <br /> 001 TT L�L I k G <br /> G b. <br /> N <br /> E <br /> R C. <br /> T <br /> O <br /> R d. <br /> W <br /> F— <br /> V) <br /> G.Addil�onal Descriptions for Materials Listed Above H.Handling Codes for Wastes Listed Above <br /> U) <br /> Z) <br /> 0 <br /> r�IY I I <br /> ' 15.Special Har i ng instructions and Additional Information (� ( / <br /> Z I LJ Invoice: v-7 `c C(�IC3 <br /> Profile <br /> Z Sales Order: <br /> 0 Do not ingest <br /> Z Wear r rotective clothing <br /> In cas of emergency call:CHEMTREC 800-424-9300 <br /> 16.GEN RATOR'S CERTIFICATION:I hereby certify that the contents of this shipment are fully and accurately described and are n all respects <br /> in per condition for transport The materials described on this manifest are not subject to federal hazardous waste regulations. <br /> Date <br /> PrintedAped Name Signature Month Day Year <br /> TR 17. r 1 Acknowledgement o eceipt of Materials Date <br /> A Print ped Name Signature Month Day Year <br /> P J �'FK 1 �C ��� J 1 <br /> 0 18.Tra er 2 Aanowtedgernent of Receipt of Materials Date <br /> RPnnted lyped Name S gnalure Month Day Year <br /> E <br /> R <br /> F19.Disc ancy Indication Space <br /> � f <br /> C �l-{ <br /> 1 20.Facif y Owner or Operator:Certification of receipt of the waste materials covered by this manifest,except as noted in item 19. <br /> L <br /> Date <br /> T Print ped Name Signature <br /> Y Month D. Year <br /> 3 <br />