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Evergreen Envir nental Services <br /> Containerized Services N_ 4605-8, <br /> dedicated to the protection of the enrironment <br /> To schedule a pickup, call Send payment to: SaleslX9fQtiir • <br /> 800-596-9455 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 P.O.BOX 30217 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles,CA 90030-0517 Date: <br /> GENER ORIJOB LOCATION BILLING INFORMATION <br /> NAM i�^ AME CASH Q CHECK <br /> �1�j .toy # <br /> DRE � � / ADDRESS CUS COMER CODE No. � <br /> t� <br /> Y STATE ZIP CO. CITY STATE ZIP CO. O# <br /> HO O. PHONE NO. PROFILE NO. U WMER EPA ID <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, L/ <br /> Dcbds contaminated with troleum h drocarbons W <br /> Nan-RCRA Hazardous Wast,,Solid(Soil, <br /> Debris contaminated with cVol_.,h dtoearbons <br /> Waste Corrosive Liquids,n.o.s. <br /> Waste Flammable Liquids,n.o.s. (� 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 /> ,4 <br /> Non Hazardous Solids <br /> Glycol Bulk 50/50 <br /> Glycol Bulk Conc. <br /> TOTAL CHARGES <br /> TSDF <br /> Evergreen Oil,Inc. ❑ CFR ❑ <br /> 6880 Smith Ave. 33210 Western <br /> Newark,CA 94560 Union City,CA 94587 <br /> CAD980887418 CAL000091507 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: ❑ Collection Station LJGovernment 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 /> -imply with the more stringent requirements applicable to hazardous waste management facilities.California facilities that handle or process used <br /> I 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. It is lawful 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 ements.This notifi ion is for information purposes only. <br /> nrivc+r Ci hrrn Pr,i�t Nomau_-- <br />