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Evergreen Envir: nental Services <br />Containerizud Services <br />-. dedicated to the protection of the environment <br />To schedule a pickup, call Send payment to: <br />800-596-9455 Evergreen Oil, Inc. <br />6880 Smith Ave., Newark, CA EPA# CAD982413262 Dept. LA 23234 <br />16540 S. Safi Pedro St., Carson, CA EPA# CAD982413262 Pasadena, CA 91185-3234 <br />GENERATOR/JOB LOCATION BILLING INFORMATION <br />No 50613 <br />Sales Order# W0-(c2j-1yU <br />Date: <br />N `0� <br />NAME <br />C ASH 0 CHECK <br />Waste Latex Paint (Non-RCRA) <br />AD L <br />ADDRESS <br />CUSTOV ESN <br />Waste Aerosols Cans <br />CITY ST)XE, ZIP ,CO. <br />cv 74 <br />CITY STATE ZIP CO. <br />PHONE NO. --[-PROFILE NO. <br />P # <br />CUSTOMER EPA ID NO. <br />PHONE NO. <br />Waste Corrosive Liquids, n.o.s. <br />Waste Flammable Liquids, n.o.s. <br />PRODUCT <br />WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br />CODE NUMBER <br />Waste Latex Paint (Non-RCRA) <br />Waste Latex Paint (Non-RCRA) <br />Waste Paint Related (Flammables oil based) <br />Waste Paint Related (Flammables oil based) <br />Waste Aerosols Cans <br />Non-RCRA Hazardous Waste. Solid (Soil. <br />Debris contaminated with etroleum h drocarbons <br />Non-RCRA Hazardous Waste. Solid (Soil. <br />Debris contaminated with petroleum hydrocarbons) <br />Waste Corrosive Liquids, n.o.s. <br />Waste Flammable Liquids, n.o.s. <br />Waste Flammable Liquids, n.o.s. <br />Non-RCRA Hazardous Waste, Liquid <br />Non-RCRA Hazardous Waste, Liquid <br />r <br />Waste Toxic Liquids or Solids (Class 9) <br />Waste Oxidizing Liquids or Solids <br />Drained Used Oil Filters <br />Empty Drums <br />. <br />Non Hazardous Water <br />I' <br />Non Hazardous Water <br />Non Hazardous Solids <br />Non Hazardous Solids <br />Glycol Bulk 50150 <br />Glycol Bulk Conc. <br />MOW <br />-- 4& —AIZOP-e- <br />J y2 IV6 3l t <br />TSDF <br />Evergreen Oil, Inc. CFR <br />6880 Smith Ave. 33210 Western <br />Newark, CA 94560 Union City, CA 94587 <br />CAD990997418 CAL000091507 <br />r k10 <br />Source: L)Collection Station LJGovernment c <br />9' <br />❑ Marine ❑ Agricultural ❑ Industrial ri <br />Retain sample # <br />TOTAL CHARGES <br />2T, 00' <br />enerator certifies that it has established a program to reduce the volume or <br />lantity & toxicity of the hazardous waste to the degree determined by <br />:nerator to be economically practicable. <br />_ hereby certify that I have read and have the authority to <br />bind the above listed generator to the terms on the reverse <br />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 customer's shipment of used oil may be <br />transported to a facility that is required to comply with federal regulations applicable to management of used oil, but that is not required to <br />comply with the more stringent requirements applicable to hazardous waste management facilities. California facilities that handle or process used <br />oil are required to meet those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements. <br />These include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for <br />closure and accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br />and not these more stringent requirements. This notification is for information purposes only. <br />N j <br />T`-�---- n�_---•-___ nom_. wr.._..._� n.,...,, uL � L`� ,^ _ `p <br />