Laserfiche WebLink
05/23/2011 MON 15: 56 FAX 209 667 1124 Blackmun Equipment ®010/029 <br /> a <br /> Evergreen Envilmental Services No- S S 3 8 2 <br /> Containerized Services <br /> / dedicated to rhe protection of the Hrvimmnrm <br /> To schedule a pickup, call Send payment to: //,/�, <br /> Sales Order#(�Lr 6y� <br /> 800-596-9455 Evergreen oil,Inc. <br /> 6x80 SmidlA,c.,Newark,r_A EPA#CAD982413262 Dep(.LA 23234 <br /> 6s4n s.sell tell l sr.,cumin,en GPA#CADW2413262 Pasadena,CA 91185-3134 Date: <br /> GENF:RATOR/JOB LOCA'T'ION HILLING INFORMATION <br /> NAMClU� � �- IFS NAME CASH[] CHECKE] <br /> r <br /> ADDRESS ADDRESS CUSTOMER CODE NO. <br /> CITY Sr'x is r/ 3f P3/-FQo� <br /> C1TY STATE, �(IP Co. CITY ­ S'1'Al'E 7TP CO. POS <br /> PHONE NO. PHONF NO, PROFILE NO, CUSTOMER EPA ID NO_ <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Waac Latex Panu(Non-Rt,:RA) <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Paint RClatcd(FTummahles oil based) <br /> Wmte Pain Related(plammshlcs oil based) <br /> WasT.Aerosols Cans <br /> Nov RCRAK"m,k wAC.$o1u!c I1. <br /> ncF,Rr. amlw�wlN iN mcuYm. <br /> Ndo-Rf.RA tluWuus wurc,Mli,l WLGnI. <br /> aeons mnnm�n.ml.;n� •wleumn mrcedn„ <br /> waste Corrosive Liquid%,n.o.s. <br /> waste Flammable liquids,n.u.s. �'Jr 'a��.--�� <br /> Waste FlammOic Liquids,n.o.s. <br /> Non-RCRAHaandnr5 Waste.Liquid 2 r ! .GnO <br /> Noa-R A ltaxardom Waste.Li aid <br /> Waste ur oli ' Class 9) <br /> Waste Oxidizing Liquid,or Solids <br /> Drained Used OiQl Filters <br /> Empty(hums <br /> Non Hazardous Water <br /> Non Ilaitardous Water <br /> Non Hazardous Solids <br /> Non Hazardous Solids <br /> _ Glycol Bulk5 5050 <br /> Glycol Bnik Couc. <br /> TOTAL CHARGES <br /> TSDF y <br /> livergrcm Oil.Inc. SA Recycling Y <br /> 6880 Sn Ave, ® 33210 Western m❑ J 7� <br /> ((( Newark CA 94560 Union City,CA 94587 <br /> CAD98(=7418 CALNM445,30 <br /> Source: Collection Station OGovemment Ceneramr entities that ithu+established a proDum to Tmucc the volume or <br /> quantity&toxicity of the ha=doux waste to the deb'ree determined by <br /> Marine ❑ Agricultural 0 Industrial generator to be ectmonucally practicable. <br /> I hereby certify that I have read and bavc the indbia i to <br /> Retain A&sample# the ahovc listed Penerator Lo the Berms on the reverse <br /> A gine or obisfornt- <br /> IMPORTANT NOTICE REGARDING;THE DISPOSITION OF YOUR OIL, <br /> Per California Health and Safely Code Section 25250.9,Rvcrgrcen hereby advises customer that customer's shipment of used oil may be <br /> transported to a facility(hat is required to comply with federal regulations applicable to management of used oil,but that is not required to <br /> comply with OTe more stringent rcquircmencq applicable to harArdous waste managcmont facilities.California facilities that handle or process used <br /> oil are required to meet those store stringunt requirements.and some out-of-state facilites that procags used oil also meet those requirements. <br /> These include murc stringent leak detection and prevention requirements,engineering cenifications of tank integrity.and financial agsuranccs for <br /> closum and accidental releases.It is lawful to send used oil to our-ol"-slate facilities that comply only with federal used oil management standards <br /> and not these mute stringent trquimmentq.This notification is for information purposes only. <br /> Driver Si are Print !Dc Route# Datc Generator's Signature Print Name Date <br />