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j Evergreen Env',lwnmental Services NO 95102 <br /> Contai ed Services <br /> / dedicated to the PMWFtion of the environment <br /> To schedule a pickup, call Send payment to: <br /> Sales Order#� <br /> 800-972-5284 � <br /> Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NALAE NAME <br /> CASH Q CHECK <br /> A S # <br /> ADDRESS CUSTOMER COW NO. <br /> CI Y ASTA.TE IP CO. CITY STATE ZIP CO. PO# <br /> P O N PHONE NO. PROFILE NO. C S dER EPA I O. <br /> ( ) a r� <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(Flammables oil based) <br /> Waste Paint Related(Flammables oil based) <br /> Waste Aerosols Cans <br /> NmrvRCRA Hazardous Wnle,Solid(Soil, <br /> Debris consaminaud wiN holwm It vbons <br /> Non-RCRA Hazardous Waste,Solid(Soil, <br /> Debnscontzminared with leumh dmcadtolu <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 /> Nan-RCRA Hazardous Waste,Liquid 4 <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 50150 <br /> Glycol Bulk Conc. <br /> TSDF TOTAL CHARGES <br /> Evergreen Oil,Inc. SA Recycling ❑ <br /> 6880 Smith Ave. 33210 Western <br /> Newark,CA 94560 Union City,CA 94587 <br /> CAD980887418 CAJM0344530 <br /> Source: ❑ Collection Station ❑Government Generator certifies that i[has established a program to reduce the volume or <br /> 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 /> Retain sample# 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 m at leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> closure cidental re ases. It is lawful to send used oil to out-of-state facilities that comply only with ral used oil management standards <br /> an these more stri ent requir .This notification is for information purposes only. <br /> � <br /> 36-716F <br /> Driver ure Print Name Route# Date Gener or's Signatur Print Name Date <br />