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Evergreen EncrironmentaI Services ° 69372 <br /> Containerized Services <br /> dedicated w the Pmtectton of the environment <br /> To schedule a pickup,cat, Send payment to: <br /> 800-596-9455 Sale-s Ordm-4,F � - <br /> 6880 Smith Ave.,N,,,k CA EPA#CADgS2413262 BlD�reen�'IIIc. <br /> 16540 S.San Pedro St.,Carson,CA EPAsf CA D982413262 -MPL LA 232134 / <br /> GENERATORIJOB LOCATION na,CA 91185-3234 Dat(: <.3' 1 <br /> N IMW G INFORMATION <br /> ADDRRSS CASH[]CHECK[) <br /> C'Giira- ® ADDRESS # <br /> CITMBR BODE NO. <br /> ]� CO. CITY STATE ��ll <br /> �' CO. PO# <br /> PHONE NO. PROFILE NO. <br /> EST <br /> ( CUSI�OMER EPA ID NO. <br /> PRODUCT WASTE <br /> CODE NU g QUANTITY UNITS PRICE <br /> Waste Latex Print(Non-RCRA) AMOUNT <br /> Waste Latex Paint(Noa-RCI2A) <br /> Waste Paint Related(Plammabtes oil based? <br /> Waste Paint Related(Flee) ? <br /> waste Aerosols Cans <br /> A <br /> wt a vrtma <br /> as Corrosive Liquids,a.o.s. <br /> Waste Flammable Liquids,n.o.s. <br /> Waste Fbtmtnable Liquids.n.o s. <br /> Noa-RCRA Haaardous Waste,Liquid <br /> Non-RCPAHazardous Waste,Liquid <br /> Waste Toxic Liquids or Solids(Class 9) <br /> Waste Oxidizing Liquids or Solids <br /> Drained Used O'J Filters <br /> Empty D <br /> Non Hazardous Water <br /> Non HazatYlous Water <br /> Non Idazatdwts Solids <br /> Non Hazunlatts Solids <br /> Glycol Bulk 50/50 <br /> Glycol Bulk Cone. <br /> t <br /> I <br /> TSD <br /> 0 880 Smt Oil,Inc. TOTAL:C1"jRGESSA RitigCeAD98080741860 Uatoa City.CA 94587CAL000344530 <br /> Source: [] Collection Station <br /> l�aIIRe ®GOVeirlT3leIIt Generator certifies that ithas established a program to reduce the volume or <br /> ®Agricultural El Industrial quantity&toxicity of the hazardous waste to the levee <br /> al generator to be economically practicable, demined by <br /> Retain Sample# I her 6Y�rtifv that r xs.- a -• v <br /> bend he a eve han..t o.,a.a. <br /> side of thT e rme orlon t <br /> IMPORTAINT NOTICE REGARD form <br /> Per California Health surd Safety Code Section 25250.9,EG ING TSE DISPOSITION Ol+YOUR 0a_ <br /> transported to a facility that is required to complywith ft green herebyadv' <br /> comply with the mote stringent requirements federal re customer that customer g shipment of used oil <br /> may be <br /> oil are reuired to meet those more stria applicable to gulations applic able to management of used oil,but that is not required to <br /> These include more stria gent requirements,and some waste management nq tents,end some out-of-state faci ities that forma facilities tftat handle or process used <br /> gent Leak detection and prevention requirements,Ongiaeeria P�e�used oil also meet those requirements. <br /> Closure and accidental releases.It is lawful to send used oil to out-of-state faeiiities that comply only with f�ezal used oil mina <br /> aid o e g certifications of tank integrity,and financial assurances for <br /> t requirements.This notification is for in pur <br /> gement standards <br /> Driver Signature Print Name n ! - °'16R �` <br />