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.a <br /> Evergreen EnvAmental Services 0 N° 80763 <br /> Containerized Services <br /> dedicated to the proter7inn of the environment <br /> To schedule as pickup,,call Send payment to: Sales Order# <br /> 800-596-9455 Evergreen Coil,Inc. <br /> 6880 Smith Am.,Newark,CA BPA&CAD982413262 Dept.LA 23234 <br /> 16540 s.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91485-3234 Date: <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NAM_E NAME CASH[]CHECK El <br /> AD RFSS ADDRESS CUSTOMER CGDE NO. <br /> CiT STATE ZII' CO. CITY STATE Z1P CO. PO# <br /> PI ONk:N PHONE NO. PROFILE NO. CUSTOMER 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(Flammablcs oil based) <br /> Waste Paint Related(Flammables oil cased) <br /> Waste Aerosols Cans <br /> Kmi-MiArt..d.a Wmae,SUMNW <br /> Mki,unxnniewttvl wi,h Ti.."h ncuixms <br /> 11; . AO,;ISu W....U 1SM1, <br /> Vr�1m 1m.dwide fgnnjc..h drrcu <br /> Waste Corrosive Liquids,n.os. <br /> Waste Flammable Liquids,n.ns. <br /> Waste flammable Liquids.nos. <br /> Non-RCRA Hazardous Waste,Liquid <br /> Non-RCRA Hazardous Waste,LiquidWaste Toxic Liquids or Solids(Class 9) <br /> Waste Oxidizing liquids or Solids .t - <br /> Drained Used Oil Filters <br /> Empty Drums <br /> Non Hazardous Water <br /> Non Hazardous_Water <br /> _ L <br /> Nan Hazardous Solids - <br /> Non Hazardous Solids <br /> _.. <br /> Glycol Bulk SOlSO <br /> Glycol Bulk Conc. <br /> TOTAL CHARGES <br /> TSDF <br /> Evvnreen OR,Inc. ❑ SA Recycling <br /> ._ 6880 Smith Ave. 33210 Westem <br /> ar <br /> Newk,CA 94560 Union City,CA 94587 <br /> CAD980887418 CAI.(M.W530 <br /> ' JOl1rC@' COI�CCIIOR SIaIt011 Generator certifies that it has established a program to reduce the volume or <br /> f( . © ❑eloventiftent quantity&toxicity of the hazardous waste to the degree deteminted by <br /> Ll Marine O.AocUltllral Ll Industrial generator to be economically practicable. <br /> Ihereby certffY that t hayg F€ad..and have th gnthurity to <br /> Retain sample# bind the above listed generator to�lLe terms on the reveres <br /> _._ sloe of this farm. <br /> IMPORTANT NOTICE REGARDING THF.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 s etection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> closure and a• ' tal releases.It's lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> and not ,e more stringent r Creme Thi tification is for information purposes ont <br />