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0E( <br />-zEvergreen Environmental Services <br />ZZContailiericed Services <br />r dedic•uted io the protection of du rn irtintnt?t1t ` ",' , <br />To schedule a pickup, call Serid payment^to <br />r <br />'EP 0 9 2006 <br />800-596-9455 Evergreen oil, fnc <br />t 6880 Smith Ave., Newark, CA EPAlt CAD9II2413262 13.0. BOX 30517 <br />S 16.540.S. San Pcdro St, Carson, CA FPA# CAD982413262 l.os Angeles, CA 90030) 051 7Deft('; <br />' GtT4' RAJ0R/J011 LOC"ATION BILLING INFORMATION <br />ION <br />AAPvII <br />MANIFEST <br />UNITS PRICE <br />NUINMER <br />Al1I0UNT . <br />r. <br />Waste Latex Pant (N)n RCRA) <br />ra. <br />Waste Latex Paint (Nein-P.CRA) <br />- <br />AM FSS _. <br />- Waste. Paint Related (Flammable.s oil based) - <br />ADDRi SS <br />Waste Paint Ralated (Fl.uninahles oil based) <br />w <br />Waste Aeio sols Cans. <br />Nm2CItA.H <br />C11M - SPATE <br />GIP CO. <br />CITY <br />STATE "I.TP C0.1- <br />_ <br />Waste Flammable Liquids, <br />Waste. Flammable: Liquids, n.o... <br />Non RCRA Hazardous Waste, Liquid- <br />)'HONE NO <br />PiIONE NO. <br />`—' ' PROFILE, NO. <br />Toxic Liquids or Solids K lass 9) <br />I <br />WASTE <br />PRODUCTQUANTI'T'Y <br />CODE <br />�f <br />MANIFEST <br />UNITS PRICE <br />NUINMER <br />Al1I0UNT . <br />r. <br />Waste Latex Pant (N)n RCRA) <br />ra. <br />Waste Latex Paint (Nein-P.CRA) <br />- <br />- Waste. Paint Related (Flammable.s oil based) - <br />-{ <br />Waste Paint Ralated (Fl.uninahles oil based) <br />Waste Aeio sols Cans. <br />Nm2CItA.H <br />­ RCRA H..­d:,u, We-, Slid (S..fl, <br />nel,rs cumairw:ated ,.illi •trnlniir 1 rirw_•!Hsml <br />Waste Corrosive Liquids, n.o.s. <br />_ _ <br />_ <br />Waste Flammable Liquids, <br />Waste. Flammable: Liquids, n.o... <br />Non RCRA Hazardous Waste, Liquid- <br />Noa-RCRA Hazardous Waste, LiquidWaste <br />Toxic Liquids or Solids K lass 9) <br />Waste Oxidizing Liquids or. Solids <br />Drained Used Oil filters. <br />-. .. - <br />Unlity Dnuns <br />4, a r <br />.,� <br />Nein f4a7ardous W.1tU <br />r - <br />--- -- - - <br />Non f lazardous Water'. -, <br />Nou Hazaalous Solids <br />Non IlazardOUS Solids <br />Glycol Bulk 50150 <br />GI col Bulk Conc. <br />C J <br />- <br />TSDF <br />j Evergrezri Oil, Inc CFR (' <br />i 7 6880 Smith Ave �> 3 M(I westrrn -. 1 <br />Newark` CA 94560 Union Ctis CA 9458 <br />G1D980887418 C'AlOW091507 <br />r01 AL (;Ih1RC,f'S <br />. F <br />P <br />M, <br />-- —_T_ -- Generator certifies that it has euablished a prograun to refit ee the volume or ' �`, Y <br />Source. ] Collection Station ❑ Government ` ""'° <br />quaputy & toxicity ot, the ha[ rdqus waste to the Degree deter nifie t by ia;� e r ti.b1 <br />f�aL1I2C "c leratol to lie ulnolitic fly r I usable K <br />Q ❑ Agricultural v, industrial <br />— L hereby certtf� (hat i have read and have the authority to psi <br />bind the above listed gcncrutor to -the terms on the reverse c`3� <br />Reid1R Sc9lllp)(e # side of this form. : a <br />MPQRTANT NOTICE REGARDING THE DISPOSITION OF''YOUR OIL. <br />Per. California health and Safety Code Section 2i250.9, Evergreen hereby advi es cuctonter that customers :shipment of used oil may be <br />tr- tnsporlcd to a facility that is W(flircd to comply with federal re nilations applicable. to'inanagenient.pt uscd od, but that:is not required to <br />comply vndth the morr stringent requirements'applicable to hazardous.wt.vle managcmcnt facilities. C'alifonna facilities thathandle.ot process used <br />.oil are required, to meet those more stringent requirements, and some oiit-of Skite, facthtteS that process u.¢ed nil also meet those requirements. <br />These include niore stringent leak detection and prevention requirements; engineering certifications of tank integrity; and financial assurances for <br />closure and accidental releases. It is lawful to ;endused oil to out-of=state facilitics,t.hal comply only with federal used oil management standar6s <br />and not ther;c more stringent requirements. This notillcatxln i4f or information purposes only. l <br />el <br />:.not i\,inie ; <br />Driver Sitrnalure Pritlt Nnme Rrntlo # Bate Gen tslttii ti tiiun.tinrc-4 r P (Data <br />