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J <br /> Evergreen Envi. amental Services N° 55821 <br /> Containerized Services <br /> dedicated to the protection o/the eavironntent <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.Stan Pedro St..Corson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: <br /> 1—/9 <br /> GE RATOR/JOB LOCATION BILLING INFORMATION <br /> N _ NAME CASH Q CHECK E] <br /> D ADDRESS O C D NO. <br /> T S CO. CITY STATE ZIP CO. PO# <br /> PtIONE N ^� NO. PROFILE NO. T MERE ID / <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 Hazardous Waste.Solid - <br /> Debris contaminated with netrol,.m h drocarbons) •,jam''"" <br /> Nun-RCRA Hazardous Waste,Solid(Soil, <br /> Debris contaminated with troleum h dmcarbons) <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 Q <br /> Non-RCRA Hazardous Waste,Liquid <br /> Waste Toxic Liquids or Solids(Class 9) <br /> Waste Oxidizing Liquids or Solids <br /> Drained Used Oil F ers <br /> Empty Drums <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 /> r <br /> TOTAL CHARGES <br /> TSDF / <br /> ❑ Evergreen Oil,Inc. CFR El <br /> 6880 Smith Ave. 33210 Western <br /> Newark,CA 945 Union City,CA 94587 <br /> CAD980887418 CAL000091507 <br /> Source: ❑ Collection Station L)Government 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 /> ❑ Maiine ❑ 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 certificatdons of tank i ty,and financial assurances for <br /> closure and accidental releases.It is lawful to send used oil to out-of-state facilities!th ith donly weral sed oil r nt standards <br /> and not these more stringent requirements.This notification is for information purp only <br /> Driver Sienature Print NnmP Rnntt-41 Tlnta (:anarntnr'c Q;rrnott,rts P,•;,,r XT—. >1��� <br />