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2 <br /> �i Evergreen Envilemmental Services 40 N° 20800 <br /> Containerited Services <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: Sales tOfit3er�/��� <br /> 800-596-9455 Evergreen Oil, Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 P.O. BOX 30517 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles,CA 90030-0517 Date/� <br /> GENERATOR/JOB LOCAT40N BILLIN ORMATION <br /> U U NA CASH❑ CHECK❑ <br /> ADD ESS � 2C firlfl - <br /> D - <br /> CI S O. ITY STATE_ 2112,jCO,r PO# (/ <br /> 73 <br /> PHONE:PO PHONE NO. PROFILE NO. CUSTOMER EPA NO. <br /> ( ) ^ y/ ( ) <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(Flammables oil based) <br /> Waste Paint Related(Flammables oil based) <br /> Waste Aerosols Cans <br /> Non-RCRA Hazardous W..,Solid Boil, <br /> nebm conmminaM win mmleum M1 dmembons <br /> Non-RCRA Hazardous Wss4,Solid(Soil, <br /> nebris onwminnmdwln ualeumhydmcabono <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 Fil <br /> Empty Drams <br /> Non Hazardous ter <br /> Non Hazardous Water <br /> Non Hazardous Solids <br /> Non Hazardous Solids <br /> Glycol Bulk 50150 <br /> Glycol Bulk Conn. <br /> TOTAL CHARGES <br /> TSDF <br /> Evergreen Oil,Inc. ❑ CFR El <br /> Smith Ave. 33210 Western <br /> Newark,CA 94560 Union City,CA 94587 <br /> CAD980887418 CAL000091507 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: ❑Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> generator to be economically practicable. <br /> L)Marine L] Agricultural Ll Industrial <br /> I hereby certify that I have read and have the authority to <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 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 stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for <br /> closure and accidental releases. It is lawfultosend used oil to out-cif-state facilities that comply only with federal used oil management standards <br /> and not these re stringentre uq irements. This notification is for information purposes only. <br /> Driver Sienature Print Name Rnute 0 Hare llunurornl c: o n . *r r _•_ <br />