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NO 1AZARDOUS WASTE MANN 3T <br /> EES19 <br /> I Generator s US EPA ID No Mar"'.5t 2 Page I <br /> ON-HAZARDdUS , <br /> ASTE MANIFESTNH '_ at 1 <br /> l 13 Geneia Jar s Name and Mad,ny;Address <br /> 1 <br /> 4 Genera tar a f'rK>t`4 1 <br /> 5.DanW nor 1 Company Name 6 u5 EPA ID Number A.51ate Transp_.rtar a 1D <br /> EVERGREEN ENVIRONMENTAL SERVICES I CAD982413262 Ei Transpener r Phone 510 795-4400 <br /> 1 Transc rter 2 Company Name 6 US EPA ID Numas• C State Transxrle,s t4 <br /> L I I D Transporter 2 Phone <br /> 9.Design ited FOC ry Name and Site Addem 10 US EPA rD Number E Slate Fond ry s ID <br /> l <br /> 'EVERGREEN OIL, INC. F Facility Phone <br /> 6880 Smith Avenue <br /> f Newark.CA 94560 1 CA0980887418 1 510795-4400 <br /> it-WAS1 E DESCRIPTION 12 Centa,ners 13 14 <br /> Total Unit <br /> tic Type Ouantdy M)W. <br /> Non-H zaraous waste,liquid <br /> G <br /> 001 TT -- T4 <br /> E <br /> N <br /> E --- - <br /> R <br /> A � <br /> O <br /> Rd <br /> W <br /> H <br /> Q- G.Admit nal Des rimions for Matenals Listed Above H.ha ns.G70es for 1'lastBs L3t4v7 AbUti+e <br /> e <br /> C! I <br /> D <br /> Q15.SDedai Randirng?ns,rucvons and Addrbc+ral Iniarmabon <br /> Invoice: <br /> ZProfile Sales Order: <br /> O Do not It <br /> Z Wear Protective cloffling <br /> 0 <br /> I*i6GEN <br /> sed of emergency call-CHEMTREC 800.424-9300 <br /> WRATOR'S CERTIFICATION:I roerevy cenify that the contents of this shipment are fully and accurately described and are in as reepscts <br /> o pr _,cgryAan for eran.Wel The melenals described on this merAasil are not sublsct to federal hazardous.waste regulations <br /> Date <br /> Printed>fypea Name Signature Month Dav Yea+ <br /> T <br /> Oahe <br /> 17. r 1 AdutpwledQem m 01 MOcetpt of Matanate ' <br /> S•gnature Akxrlh Day Year <br /> Pnntea yped Nan* <br /> 18, K 2 Advietent of Rece+pl d Matansb <br /> Ode <br /> Print Vp d Nama Signature Month Day Year <br /> 19 O sc epancy Indrutron Some <br /> F <br /> !h <br /> V I <br /> L 20 Fecl ty Ownar or Operator Cermicabon of recerrl ci the waste rralenals eoverod oy this manifest.escept as noted In dem 19 <br /> Date <br /> TP ntedl yped Nana Se rature Matin Day Year <br /> Y <br />