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12/29/2011 10:14 2093408652 LODI HONDA PAGE 01 <br /> 4V <br /> J <br /> ; 8 <br /> No 23-1 <br /> Evergrean. Environmental, Services <br /> Containerized Services <br /> dedicamd to the protection of the envirowdAl <br /> c <br /> 'OF To schedule a pickup, call ,Selid payment to: <br /> Sal(2 1rf <br /> 800-596-9455 Evergreen Oil, Jnc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 P.O. BOX 30517 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles, CA 90030-0517 Da <br /> GENERATOR/JOB LOCATION BILLING INFORMATION. <br /> NAME/ NAME <br /> CASH CHECK <br /> # <br /> Cr, '01MER, <br /> ADDRESS <br /> A9 <br /> CITY <br /> 0 <br /> � STATE ZIP P <br /> ,!�ATE - CO. CITY <br /> gee <br /> PHONE NO. PHONE NO. FIRR—O—FILE.NO. CUSTONIER rKPA ID NO. <br /> PRODUCT WASTE MANDE ST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Waste.Latex Paint(Non-RCRA) <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Paint Related(Flainmablr-s oil based) A,—,. <br /> " 1".. <br /> Waste Paint Related(Plarnmables oil based 9 � 1-� <br /> N--z,K �%90( 1410 <br /> Waste Aerosols Cans — <br /> N,,,RCRA Hazanfous Wostc Solid(Soik <br /> lyroleam hydnKaftn"? <br /> n P r j.11 <br /> Waste Corrosive Liquids,n.o.s. <br /> Flaint-nable Liquids,n.o.s. <br /> 'Waste Flammable Liquids,n.o.s. L <br /> Non-RCRA Hazardous Waste,. Liquid <br /> ,;i-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 /> Iron 144ardous Water <br /> on riazardous Water <br /> ALL'r <br /> Non Hazardous Solids <br /> P <br /> Non Hazardous Solids <br /> Glycol Bulk.50150 <br /> Glycol Bulk Cone. <br /> A I'Mig <br /> �!i-!UN A I U M <br /> TOTAL.CHARGES <br /> TSDF <br /> EEvergreen Oil,Inc. r' C r rte; <br /> l 6830 Smith Ave. 337210 Western <br /> Newark,CA 94560 Union City,CA 94587 f <br /> CAD980987418 CAL0000§1507- r <br /> Generator certifies that it has established a program to redtic.e the.volume or <br /> ree: Q Collection Station Q Government &quantity toxicity of the hazardous waste to the degree de-r4prined by <br /> El Madre Agricultural ❑ Industrial generator to be economically practicable. <br /> N <br /> 110 U Ll I hereby certify that fhave-read and have the JIL*-L4 to <br /> bind the:above-liste(l zenerator-to the terins on-the reverse"" <br /> Retain sample side of this form. <br /> IMPORTANT NOTICE REGARDINGTHE DISPOSITION OF YOUR OIL. <br /> Per California Health and Safety Code Section 25250.9, Evergreen hereby advisee customer that customer's shipment of used oil may be <br /> transported to a facility that is requimd 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, en. <br /> gaineering certifications of tank. inte(Ifity, arid financial assurances for <br /> closure arid accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil*management staridards- <br /> and not these mgM stringent requirements. This notification is for information purposes only. <br /> 10 C:7 <br />