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NO 95297 <br /> j Evergreen Envi*mental ServiceRECE*EID <br /> / Containerized Services <br /> / dedicated to the protection of the environment <br /> To schedule a pickup,call Send payment to: AUG 2 3 2013 Sales Order# �W <br /> 800-972-5284 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23ENVIRONMENIA; g .� /3 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185 A9tTH DEPARTMENT ate: <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NAME - NAME CASH[]CHECK <br /> ADDRESS ADDRESS CU TOMER CODE NO. <br /> � v <br /> CITY STATE zip CO. CITY STATE ZIP CO. P # <br /> PH NE NU. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> tw Mk--&K1 ) <br /> PRODUCT 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(Hamrnables oil based) <br /> Waste Aerosols Cans <br /> Non-RCRA Hervdaua Wss@.Solid(soil. <br /> cemiW coammmataa wim larmh dm<a.eoK <br /> Hon-RCRA Hvalloua Wum,Solid(Soil, <br /> peb, <br /> '.ei nmrA wati Iwmh d.c . <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 /> Waste Toxic Liquids or Solids(Class 9) <br /> Waste Oxidizing Liquids or Solids <br /> Drained Used Oil Filters <br /> Empty Drums <br /> Non Hazardous Water <br /> Non Hazardous Water <br /> Non Hazardous Solids <br /> Non Hazardous Solids <br /> Glycol Bulk 50/50 <br /> Glycol Bulk Cone. <br /> TOTAL CHARGES <br /> TSDF <br /> ❑ Evergreen Oil,Inc. SA Recycling ❑ <br /> 6880 Smith Ave. 33210 Westem <br /> Nev CA 94540 Union City,CA 94587 <br /> CAD980887--- CAL000344530 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: ❑ Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑ Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> bind the above listed generator to the terms on 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 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 ' gent req <br /> irements applicable to hazardous waste management facilities.California facilities that handle or process used <br /> oil are re to meet tho a mu <br /> ore stringent requirements,and some out-of-state facilities that process used oil also meet[hose requirements. <br /> Th nclude more string t leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> osure and accidental re aces. ul to send used oil to out-of-state facilities that comply y with federal used oil management standards <br /> and not these more stri a mems.This no ' cation is for information purposes only. <br /> � tl 613 <br />