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'Evergreen Envir® cental Services <br />Containerizt:u Services <br />/ dedicated 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 Dept. LA 23234 <br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Pasadena, CA 91185-3234 <br />GENERATOR/JOB LOCATION BILLING INFORMATION <br />Sales 'Order # g� <br />Date: %� <br />NAME <br />WASTE MANIFEST QUANTITY UNITS <br />CODE NUMBER <br />NAME <br />Waste Latex Paint (Non-RCRA) <br />CASH ❑ CHECK <br />Waste Latex Paint (Non-RCRA) <br /># <br />AD13RESS <br />IADDRESS <br />Waste Paint Related (Flammables oil based) <br />CUSTOMER CODE NO. <br />r/ rcS— C <br />J;00"- �la�'e- <br />Non-RCRA Hazardous Waste, Solid (Soil, <br />Debris contaminated with evoleum h drocarbons) <br />ldw/ i f// <br />CIITY <br />STATE ZIP CO. <br />CITY <br />STATE ZIP CO. <br />PO # <br />Waste Flammable Liquids, n.o.s. <br />PHONE ON_E N�O..t <br />PHONE NO. <br />Non-RCRA Hazardous Waste, Liquid <br />PROFILE NO. <br />CUSTOMER EPA ID NO. <br />�� <br />(37&p)- <br />Waste Toxic Liquids or Solids (Class 9) <br />PRODUCT <br />WASTE MANIFEST QUANTITY UNITS <br />CODE NUMBER <br />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 />Debris contaminated with evoleum h drocarbons) <br />'^ <br />Non-RCRA Hazardous Waste, Solid (Soil, <br />Debris,with etmleum 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 Oil Filters <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 Cone. <br />TSDF <br />Evergreen Oil, Inc. SA Recycling <br />6880 Smith Ave. 33210 Western <br />Newark, CA 94560 Union City, CA 94587 <br />CATMORR741 R CAi.000344530 <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 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 accid eases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br />and no a more stringers equirements. This notification is for information purposes only. <br />