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-� 0 <br /> Evergreen Envirwimental Services N_ 559 <br /> Containerized Services <br /> dedicated to the protection of'the enviwnnrent <br /> To schedule a pickup,call Send payment to: Sales Order# <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 <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> Nn/ NAME CASH F] CHECK E]` # <br /> ADD S ADDRESS U T R D NO. <br /> STATE P _ CITY STATE ZIP CO. # <br /> PHONTE NO PHONE NO. PROFILE NO. C STOM E A ID NO. <br /> ( ( ) + <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 H—dous Waste.Solid-"W6 <br /> Non-RCRA H,zardous Waste.Solid(Sail, v <br /> Debris comaminaced wish voleum h drocarbons <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 O' Filters <br /> Empty Drums,.-- <br /> Non <br /> rums 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 /> TSDF <br /> Evergreen Oil,Inc. CFR <br /> 6880 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 /> ❑ 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 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 tha ly with federal used oil management standards <br /> and not these more stringent requirements.This notification is for information pu ses only. <br /> ,�..:.. _r: (:an 'c 4ianatnre Prin P Date <br />