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Evergreen Enviremental Services <br /> Containerized Services <br /> "Opo dedicated to the protection of the environment <br /> To schedule a pickup,call Send payment to: Sales Order# S Z- <br /> 800-596-9455 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 �� . <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 late: <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> N E J NAME CASH Q CHECK E] <br /> # <br /> DDRESS ADDRESS CUSTOMER CODE NO. <br /> CITY STATE IP CO. CITY STATE ZIP CO. PO# <br /> 10 <br /> P N O. PHONE NO. PROFILE NO. C TO ER EPA ID NO. <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 Waste,Solid(Soil, <br /> Debris contaminated with Oleum h drocarbons <br /> Non-RCRA Hazardous Waste,Solid(Soil, <br /> Debris contaminated with petroleum hydrocarbons) <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 <br /> Empty Drt <br /> Non Hazardous Water <br /> Non Hazardous Water <br /> Non Hazardous Solids <br /> Non Hazardous Solids <br /> Glycol Bulk 50/50 <br /> Glycol Bulk Conc. <br /> TOTAL CHARGES <br /> SDF <br /> Evergreen Oil,Inc. SA Recycling <br /> 6880 Smith Ave. 33210 Western El <br /> Newark,CA 94560 Union City,CA 94587 <br /> CAD980887418 CAL000344530 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: ❑ Collection Station ❑Govemment quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑ Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <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 includqweK stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> closure accid tal releases.It is lawful to send used oil to out-of-state facilities that comaly only with federal used oil management standards <br /> an t these r ngent requirements.This notification is for information purposes 0 <br />