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J <br />Evergreen Envhyamental Services <br />Containerized Services <br />lvpdedicated to the protection of the environment <br />To schedule a pickup, call Send payment to: <br />800-596-9455 Evergreen Oil, Inc. <br />6880 Smith Ave., Newark; CA EPA# CAD982413262 P.O. BOX 30217 <br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Los Angeles, CA 90030-0517 <br />GENERATOR/JOB LOCATION BILLING INFORMATION <br />No 46315 <br />Sales Order # <br />Date: �' e <br />C STATE .I/ CO. <br />NAME <br />ADDRESS <br />CITY <br />CASH Q CHECK Ef— <br />QMER C�E0.N <br />STATE ZIP CO. P <br />�^ on KO. <br />PHONE NO. <br />PROFILE NO. CUSTOMER EPA ID NO. <br />i <br />PRODUCT WASTE, <br />CODE <br />MANIFEST <br />NUMBER <br />QUANTITY UNITS PRICE AMOUNT <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 Waste, Solid (Soil, <br />Debri.scontaminated with tmleum h drocarbons <br />Non-RCR Hazadous <br />rWaste, o i (oil, <br />Debris contaminated with petroleum hydrocarbons) <br />.� <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 Fi rs <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 />TSDF <br />Evergreen Oil, Inc. CFR <br />6880 Smith Ave. ❑ 33210 Western ❑ <br />Newark, CA 94560 Union City, CA 94587 <br />CAD980887418 CAL000091507 <br />TOTAL CHARGES <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 />❑ Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br />I hereby crtify that I have read and have the authority to <br />Retain sam le # bind the above listed generator to the terms n he reverse1� 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. Califomia 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 certificatio c tntegn nancial assurances for <br />closure and accidental releases. It is lawful to send used oil to out-of-state facilities that co only with federal used oil ma ement standards <br />and not these more stringent requirements. This notification is for information pus o y. <br />Z/// �-��purposes <br />,,,/ � "�,� the <br />