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Evergreen Enviro•--la1 ServieeSe . a Wora-rder . <br /> AWdedicdred to the prarecfion of rtix��,t;irrytn4errt .• ., Bill 6Arding W00-38E391 <br /> To schedule a pickup,call Send Payment to: <br /> 800-596-9455 Evergreen oil Inc Customer C00045 <br /> or 510-795-4400 Dept.of LA 23234 <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Pasadena,CA 91185-3234 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 <br /> , <br /> Pickup Location: Bill To: <br /> COCACOIAREFRESMOTSUSAINC COCACOfAREMESHUMTSUSAINC <br /> 467 EL PINAL OR 1553 OLD EAYSHORE RW <br /> CC-A437 ATTN FLEET DEPT' - <br /> SrOCKTONCA 95. 3 34NJOSECA 24112 <br /> Contact: <br /> NOTE C2A7j 5 1 370 i7 CA l <br /> COST NO. EPA NO. TERMS PURCHASEORDER.NUMBER ) TERRITORY <br /> .DATE 'BOE NO. Illgroup I .OIL ROUTE 1PROFILE I PROFILE I PRIME BY <br /> tSol <br /> .41eno Descnpbon ManffgstNa - UnttAdce Artiount._. . <br /> Pickup. .. - :... n_ .. .. <br /> ,fas.aa �U' -Rcu F-uA3DDnS WASTE, Imalub/ <br /> 2�.aa Y LCUM $0 IDI 9URCP.ARSE 4ATSe1PS <br /> IAS (� DYLY SAHOWS`RdaaYUA2].v'2U$ �—• ST$.�T__ <br /> 8i7UU3 FIR <br /> � t <br /> i <br /> Y i(AV l�i?� t(12- <br /> TSDF ❑Consolidated Manifest DRIVER CHECKLIST <br /> I-�,-EwMee.01 be, Enquecn Oil.la.-iWis ❑Etjccu W,In. Res. <br /> 'L-V 6MSmid,Ave. R.03011 4139N.9alenam <br /> NmarLCA94%0 Davis.CA95616 Fresno.CA 93722 <br /> CAD98d887418 CADW-446874 CAD982446881 -owe.�dN-r-aw,cra, <br /> ❑Evermca Env.Svc.❑Evergmn OiLlne StsuNau SA Recycling o<mrs.,vrmwaronoran ar.maea:a <br /> 16607 Sm 0rAm 745 A aea Eete.iu ❑33210 Warm oaw�w..w.:..,,.,rtaoa�naw,.�somnoaau <br /> Came.CA 00746 Same Mute,CA 9.1454 Union City,CA 94387 - <br /> CAD9816964-10 CAD931146838 CAL000344530 <br /> , <br /> Generator eenifics dut it has ssnblisletl a program w reduce the voloae or <br /> Source: []Collection Station []Government quantity&toxicity of the 6azvdous muse rade deeree&4ctmined by <br /> ^znnata m be xa,emicolly practicable. <br /> ❑Marine ❑Agricultural ❑Industrial I hereby a tifv that 11have read and have the authority <br /> to bind the above Listed venerator to the ten the <br /> Retain Sample# reverse side of this foray, <br /> INfPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br /> Per California Health and Safety Code Section 25250.9,Evergreen hembv advises customer that customer's shipment of used oil may be transported to a facility <br /> that is required to comply with federal regulations applicable to management of used oil.but that is not required to comply with the more stringent requirements <br /> applicable to hazardous waste mmzagcment facilities.California facilities that handle orprocess used oil are repaired to meet those more stringcanquirements,and <br /> some outW-slate facilities that process used oil also meet those requirements.Tlsese htetode more stringent leak detection andppcvention sequvemeats•engincei er <br /> certifications of mnk integrity,and financial assurances for closureand accidental releases.It is lawful to=ad used nil to out-o state Psdlities that comply only <br /> with fed�eral/wed <br /> oil <br /> cmanagement standards <br /> and not these more stringent requirements.This notification is for information purposes only. <br /> 0 _.A'4r - �`.(r�s --1-C— Zze�> /112J,� AStlfiw-r UlWj, :fl^/ft <br /> river S� i6atu re Print Name Route 9 / Date Generator's Signature Print Name Date <br />