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J <br />Evergreen Envi lmental Services <br />Containerized 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 # <br />Date: 1017c -k1> <br />NAME �e,04 �It �s <br />NAM S� <br /># ASH Q CHECK <br />ADDRESS//++� <br />(../rEfiF�rer 4 X <br />ADDRESS <br />7 <br />CUSTOMER CODE NO. <br />CITY%%,�� �A cSTATE ZIP CO. <br />lam 45 64-c ! <br />CITY/ �, STATE ZIP <br />LVii 1, C+1 e <br />PO # <br />PHONE NO. <br />O <br />PHONE NO. <br />( ) <br />PROFILE NO. <br />CUSTOMER EPA ID NO. <br />PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE <br />CODE NUMBER <br />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 petrolcurn hydrocarbon <br />Non-RCRA Hazardous Waste. Solid (Soil, <br />Debris contaminated with troleum 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, Liqui <br />Non-RCRA Hazardous Waste, Liquid. <br />Waste Toxic Liquids or Solids (Class 9) <br />Waste Oxidizing Liquids or Solids <br />Drained Used ' Filters <br />Empty Drums VrSDm4m1Z <br />Non Hazardous Water ll <br />Non Hazardous Water <br />Non Hazardous Solids <br />Non Hazardous Solids <br />Glycol Bulk 50/50 <br />Glycol Bulk Conc. <br />Z" n1c, <br />Ae4d 1;1� <br />TOTAL CHARGES <br />TSDF <br />68L;)� 6'-880 rOil, Inc. Recycling �,4 Recycling <br />80 Smith Ave. 33210 Western <br />Newark, CA 94560 Union City, CA 94587 GS <br />CAD980887418 CAL000344530 <br />Generator certifies that it has established a program to reduce the volume or <br />Source: LJ Collection Station LJ Government quantity & toxicity of the hazardous waste to the degree determined by <br />L] Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br />7 L.....L.. ....-L-V ♦L..a 7 L...... -....,1 ._-_1 <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 accidental releases. Itis 1 ful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br />and not these more stringent re ti <br />is. This notification is for information purposes only. <br />147f. Im <br />Ti T nr Cr n.. nfr,Yn v�r.h T--- I[)-1- 4 ..L.. "-.'._. hT_.__ <br />