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a <br />Evergreen Environmental- Services <br />Containerized Services _ <br />dre icated to the protection of the environmlit <br />To schedule a pickup, call Send payment"to: <br />800-596-9455 Evergreen Oil. Inc. <br />6980 Smdh Ave., Newark, CA CPA# CAD982413262 <br />16540 S. San Pedm St., Carson, CA EPA# CAD982413262 <br />} GENERATOR/JOB LOCATION <br />i1 <br />Dept. LA 23234 <br />Pasadena, CA 91185-3234 <br />BILLING INFORMATION <br />N° 6567 <br />Sales Ordet <br />P' <br />Date: ;�✓�' ! <br />yNAM <br />NAME <br />CASHE] CHECK EJ <br /># <br />DRESSADDRESS <br />ADDRESS-2.r <br />!/j`I y <br />CITY/ STATE <br />j ZIP. CO. <br />CITY <br />STATE ZIP CO. PO# <br />PHONE NOK <br />PHONE NO. <br />PROFILE NO. CUSTOMER EPA ID NO. <br />PRODUCT WASTE MANIFEST <br />CODE NUMBER <br />QUANTITY UNITS PRICE AMOUNT <br />Waste Latex Paint (Non-RCRA) <br />Waste Latex Paint (Non-RCRA) <br />Waste Point Related (Flamrtables oil based) <br />Waste Paint Related (Flammables oil based) <br />Waste Aerosols Cans <br />Nom RCRA HinaN Wm#. Soud(Soil. <br />Dinh—oo "hod with onnoleam hdWariont <br />N N6, to t Havadouv W Minso1W (Soil. <br />Dcdi�on(rt inuW wiVt (lokanA drtcaWns <br />Waste Corrosive Liquids, n.o.s. <br />Waste Flammable Liquids, ri <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 Drams < <br />Non Hazardous Water <br />" <br />Non Hazardous Water <br />Non Hazardous Solids <br />Non Hazardous Solitts <br />Glycol Bulk 50/50 <br />Glycol Bulk Cone. <br />TSDF <br />❑Evergreen Oil. Inc. SA Recycling <br />6880 Smith Ave. ❑ 33210Westem ❑ <br />Newark, CA 94560 Union City, CA 94587 <br />CAD980987418 CAL000344530 <br />Source: Collection Station <br />❑ ❑ Government <br />❑ Marine ❑ Agricultural ❑ Industrial <br />TOTAL CHARGES <br />?(�--- ___ <br />Generator certifies that it has established a program to reduce the volume or <br />quantity & toxicity of the hazardous waste to the degree determined by <br />generator to be economically practicable. <br />bind the above listed generator m the terms on the reverse <br />Retain sample # side of this firm. <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 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 information purposes only. <br />3 <br />Driver Sienature Print Name Route # Date Gcneratu is Sionantre. Print Name nate <br />