Laserfiche WebLink
s a <br />'A'd Ever green DWI- imental Services <br />Contain.- --d Services <br />dedicated to the protection of the ennrrwtment <br />To schedule a pickup, call Send payment to: <br />869-596-9455 Evergreen Oil, Inc. <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 <br />GENERATOR/JOB LOCATION BILLING INFORMATION <br />N2.22789 <br />—%5ales Order # <br />NAME/f..`1AME <br />PRICE AMOUNT <br />Waste Latex Paint (Non-RCRA) <br />CASH Q CHECK <br />Waste Latex Paint (Non-RCRA) <br />Waste Paint Related (Flammables oil based) <br />Waste Paint Related (Flammables oil based) <br />ODRSS�ADDRESS <br />Waste Aerosols Cans <br />Non-RCRA Hazardous Waste, Solid (Soil, <br />Debn, contaminated with etroleum h drocarbons) <br />CLiS3 O1ER CODE NO <br />Non-RCRA Hawrdous Waste, Solid (Soil, <br />Debris contaminated with pamieum hydrocarbons) <br />Waste Corrosive Liquids, n.o.s. <br />Waste Flammable Liquids, n.o.s. <br />CST-- <br />- STA ZIP'; CO. <br />CITY <br />STATE ZIP Co. <br />Non-RCRA Hazardous Waste, Liquid <br />fi <br />Waste Toxic Liquids or Solids (Class 9) <br />Waste Oxidizing Liquids or Solids <br />PHONE NO• <br />! <br />PHONE NO. <br />Empty Drums <br />PROFILE NO. <br />CUSTOMER EPA ID NO. <br />PRODUCT WASTE MANIFEST QUANTITY UNITS <br />CODE NUMBER <br />PRICE 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 />Debn, contaminated with etroleum h drocarbons) <br />Non-RCRA Hawrdous Waste, Solid (Soil, <br />Debris contaminated with pamieum 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 Hazardous Waste, Liquid <br />Waste Toxic Liquids or Solids (Class 9) <br />Waste Oxidizing Liquids or Solids <br />,c <br />Drained Used Oil Filters <br />Empty Drums <br />Non Hazardous Water <br />Non Hazardous Water <br />Non Hazardous Solids <br />Non Hazardous Solids <br />Glycol Bulk 50150 <br />Glycol Bulk Conc. <br />TSDF <br />Evergreen Oil, Inc. CFR ❑ <br />6880 Smith Ave. 33210 Western <br />Newark, CA 94560 Union City, CA 94587 <br />CAD980897418 CAL000091507 <br />TOTAL CHARGES. <br />,— }- <br />�: _ <br />Generator certifies that it has established a program to reduce the volume or <br />Source: Q Collection Station ❑ Government quantity & toxicity of the hazardous waste to the degree determined by <br />U Marine Cj Agricultural Ll Industrial aenera[or to he 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 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 accidentA, 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 mow`siringent requirements. This notification is for information purposes only,__, <br />Driver Signa -Lure Print Name Route # Date Gen*erator�s Si g11,91 PrInT Ngilip 1nrP <br />