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Evergreen Envir�mental Service NO 4 0 I' <br /> r, Cmhepro Services �ECEIV ED <br /> dediz'na'r(ru lhr proRrNar n/'dre enriernnrrnl <br /> To schedule a pickup, call Send payment to: <br /> 800-972-5284 Evergreen Oil, Inc CCT 21 2013 Sale: Order# _--. <br /> 6NSU.Somh All.Ncwork,CA GP.Ai'CAD9S241326_2 Dept. LA 23234 <br /> 16540 S.San Pedro S6,Carson-CA EPA#CAD99241.4262 Pasadena.CA 91 Ir te: <br /> Nu►RONMENTAI� <br /> GENERATOR/JOB LOCATION _ BILLING INFORM1dEA�T41 DEPARTMENT <br /> NAME NADIE <br /> CASH Q CHECK <br /> ADDRESS #ADDRESS CUSTOMER CODE NO. <br /> CI Y SIAT ZIP CO. C[TY STATE. ZIP CO. PO# <br /> PHONE NO. PHONE NO. PROFILE NO. GUSTO ER EPA ID NO. <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Paint Related(Flumnmbles oil based) <br /> Waste Paint Related(Flammables oil based) <br /> Waste Aerosols Cans <br /> aMmlNAom - lnlnntuav¢JJowuwx•i�NWM1SSmuolilmJ)iIsSou�1l,. <br /> r-, wM1 M1 tlu <br /> oRURA <br /> iklx.'mmmi <br /> M1vJrrcarM1x,J <br /> Waste Corrosive Liquids,n.o.s. <br /> Waste Flammable Liquids,nos. <br /> Waste Flammable Liquids,n.os. <br /> Non-RCRA Hazardous Waste.Liquid <br /> Nun-RCRA Hazardous Waste,Liquid <br /> Waste Toxic Liquids or Solids(Class 9) <br /> Waste Oxidizing Liquids or Solids <br /> Drained Used Oil Filters <br /> Empty Drums Z <br /> Non Hazardous Water <br /> Non Hazardous Water <br /> Non Hazardous Solids -- <br /> Non Hazardous Solids <br /> Glycol Bulk 50/50 <br /> Glycol Bulk Conic. <br /> TOTAL CHARGES <br /> TSDF <br /> Evergreen Oil,Inc. SA Recycling O <br /> 6880 Smith Avc. I 33210 Western <br /> Newark.CA 94560 Union City,CA 94587 <br /> CAD980887418 CAUM344530 <br /> Generator certifies that it has established a program to educe the volume ur <br /> Source: ❑ Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree dclermined by <br /> I] Marne ❑ Agricultural Ll Industrial generator io bu economically practicable. <br /> 1 hereby certify that 1 have read and have the authority-to <br /> bind the above listed generator to the terms rot the reverse <br /> Retain sample# side of this form. <br /> IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br /> Per California Health and Safety Code Section 25250.9.Evergreen hereby advises customer that cuaomer's shipment of used oil may be <br /> t,mspoited to a facility that is required to comply with fe[Ieral regulations applicable to management of used oil,but that is not required to <br /> comply with them ingenr requirements applicable to hazardous waste management facililies. California facilities that handle or process u.rd <br /> oil mere [ to meet Ihc.e more stringent requirements.and.orae out-of-state facilities than procc>s used oil also meet those requirement.. <br /> Thr>c - u(le mors stringe t leak detection an[I prevention reyuiremcros,engineering certifications o(nmk integrity,and financial assur:mces hlr <br /> do re and accidental rete sex. It is law ,end used oil to oul-of-slate facilities that comply only scith federal used oil managrmeot standard, <br /> m not these more suing nit r s.T s.notiftcation is for inforrnation purposes onk. <br /> q � 0 /&11 V, , . i0/; <br />