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Epee green Envirc nental Services - 72941 <br /> Containerized Services <br /> dedicated to the protection of the environment <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 Date: <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NAME NAME CASH Q CHECK <br /> zee �A�w? # <br /> ADDRESS ADDRESS CUSTOMER CODE NO. <br /> s _ gee <br /> CI Y STAT P CO. CITY STATE ZIP CO. PO# <br /> 4�� <br /> PHON NO. y PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. _ <br /> ) �4Q - <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(Soil. <br /> Debris contaminated with t oleum(t drocarbons) <br /> Non-RCRA Hazardous Waste.Solid(Soil. <br /> Debris contaminated with petroleum hydrocarbons) <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 Wkk <br /> Waste Toxicor oli s(Class 9) ?-7 - <br /> Waste Oxidizing Liquids or Solids <br /> Drained Used Oil Filters <br /> Empty D <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 /> TOTAL CHARGES <br /> TSDF <br /> Evergreen Oil,Inc. SA Recycling <br /> 6880 Smith Ave. 33210 Western <br /> Newark,CA 94560 Union City,CA 94587 <br /> CAD980887418 CAL000344530 <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 m se more stringent requirements,and some out-of-state facilities that process used oil also meet those requirements. <br /> These includ a strin en leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> closure accidental eases.Itis lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> an t these more st ' gent requirements.This notification is for information purposes only. <br />