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01/1/2010 12:25 2099834012 FRENCH CAMP PAGE 01/05 <br /> Evergreen Environmental. Services W51610 <br /> Containerized Services <br /> dedicated to the prorection of the environment <br /> To schedule a pickup,call Send payment to: Sales Order#wjE 02sj�' <br /> 800-596-9455 Evergreen Oil,Inc. <br /> OsaO S'nith Ave..Newark.CA EPA#CAD982413262 Dept,LA 23234 <br /> 16540 S.San Pedro St..Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: f97 <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NAME CASH❑CHECK❑ <br /> # <br /> A RI E ADDRESS CUS C Opg). <br /> C TATE ZIP O- CITY STATE ZIP CO. PO 7 <br /> /7G <br /> HONE NO. PHONE NO. PROFILE NO, CUSTOMER EPA tD N0. <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(Flammable.,oil based) <br /> Waste Paint Related(Flammable.,oil based) <br /> Waste Aerosols Cans <br /> NOMRCRA Hwankwwatt,Solid <br /> Ixetlx (Soil. <br /> ixem rnvaminma . W"U amcaroom <br /> Nvr'RCAA areadm"WAM"v,4v1iJ ISoii. <br /> conuminmm nim � kemna <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 9. <br /> Empty Drums 1 I <br /> Non Hazardous Water \nk\- <br /> Non Hazardous Water002$► Pt0 -( <br /> Non Hazardous Solids <br /> Non Hazardous Solid,, <br /> Glycol Bulk 50/50 <br /> Glycol Bulk Cone. <br /> TOTAL CHARGES <br /> TSDF <br /> ❑ Evergreen Oil,Inc. CFR <br /> 6880 Smith Ave. ❑ 33210Westem ❑ * 10 <br /> Newark.CA 94560 Union City,CA 94587 <br /> CAD990897418 CAL000091507 <br /> Generator canities that it has established a program to reduce the volume or <br /> Source: El Collection Station El Government <br /> quantity et toxicity of the hazardous waste to the degree determined by <br /> ❑ Marine ❑ Agricultural © Industnal generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> bind the above listed emerator 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 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 Ehar process used oil also meet those requirements. <br /> Thcse 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 <br /> /stringent requirements..This <br /> notification is for information purposes only. C�� <br /> Driver Signature Print ame Route# ate Generator's Signature Punt Name Date <br />