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✓�, Evergreen Environmental Services N° 516" 0 <br /> Containerized Services <br /> dedicated to the protection of the environmrm <br /> To schedule a pickup,call Send payment to: Sales Order#1Ma02_ 3''YS" <br /> 800-596-9455 Evergreen Oil,Inc. <br /> Mao amah Ave.,Newark,CA EPA#CAD9a2,1t 3262 Dept.LA 23234 <br /> t 654n S.Saa Pedro SL,Corson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: -lip <br /> GENERATOWJOB LOCATION BELLING INFORMATION <br /> N NAME CASH Q CHECK <br /> AS ADDRESS _ >Y ADA no CUST M C EImo. <br /> CIIXY ATE ZIP CO. CITY STATE ZIP CO. Po a/ <br /> L <br /> HONE NO. PHONE No. PROFILE NO. CUSTOMER F.PA m NO. <br /> PRODUCE' 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(Flammable$oil based) <br /> Waste Paint Related(Pammables o0 baud) <br /> WasteAcrosols Caas <br /> aM-aeaa n..,eku<wave,scat ism, <br /> Ddn'vamuamirerce wish humh omvhmr <br /> on.ecaa w:wm,z w:m�,sgue tsdi. <br /> ase.mnnmmm,N witl, hokumM1 <br /> Waste Corrosive Liquids,n.o.s. <br /> Waste Flarruwhlc 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 50150 <br /> Glycol Bulk Conc. <br /> TOTAL CHARGES <br /> TSDF r2�/Y Am ci—� <br /> Evergreen Oil,ink. CFR rC <br /> 68805mith Ave. ❑ 33210 Western ❑ rt 'P <br /> Newark,CA 94560 Union City,CA 94587 <br /> CAD980887418 CALOM1507 <br /> Source: La Collection Station ❑Government Generator certifies that it has established a program to reduce the volume or <br /> quantity&toxicity of the bvardous waste to the degree determined by <br /> ❑Marine ❑Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify that 1 have read and have the authority m <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 Surety 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-slate 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 in/ormation purposes only. <br /> Driver Signature Print Name— Route# elate Generator's Signature Pr nt Name oat <br />