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Mar. 6. 2012 9: 20AM HEINZ USA No, 3333 ,P• <br /> Evergreen Env nrnental Services ia_ 7 c 5 <br /> Contatne rized Services <br /> dedicated to the protection of the environment , <br /> To schedule a pickup,call Send payment tQ: Sales Order# <br /> 800-596-9455 Evergreen Oil,Itic. <br /> 6890 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 <br /> 16510 S Sari Pedro St..Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NANJE NAM CASH E] CHECK <br /> # <br /> ADDRESS ADDRESS C NO, <br /> CITY STAT aZIP CO. CITY STATE ZIP CO. PO# <br /> Ve, <br /> f y <br /> PHON NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID N0, <br /> PRODUCT WASTE NIANNEST QUANTITY UNITS PRICE 'AMOCNT <br /> CODE NUMBER <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Paint Related(Flarnmables oil based) <br /> Waste Paint-Related(Flammables oil based) <br /> Waste Aerosols Cans <br /> Non-R=.11 <br /> RA Hvudous Wince.Solid(Soil. <br /> Debris conta +•ilh lvkyo, <br /> Non-RCRA rr Idoup Wg9ce,Solid(5oii, <br /> conlommaled wtln team 6 ,ttorbom <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 lbiic Liquids or Solids(Class 9) <br /> Waste Oxidizing Liquids or Solids 'i; > <':..::;•"' <br /> Drained Used Oil Filters <br /> Non Hazardous Water <br /> Non Hazardous Water e ' <br /> Non Hazardous Solids w r� <br /> Non Hazardous Solids <br /> Glycol Bulk 50/50 <br /> Glycol Bulk Cone. <br /> 6,0 <br /> 7777 <br /> T OTAL-CLVRGES <br /> TSF <br /> Evergreen Oil,Inc. SA Reey�hg <br /> LA 6880 Smith Ave. 33210 <br /> Newark.CA 94560 Union City;CA'9451 : ;-V <br /> '...- i" : ;..,.,.� �, `` <br /> CAD980887418 CAL000344530 ` ?p ''M1' <br /> . aaerator cettibes that it has established a program to'1educethe.volutD>w9t <br /> Source: ClCollection Station` Q:t oveIIime t,` quantity&toxicity of the hazardous waste to the degiea deteimiued <br /> E] Madne Q Aglicultural 0 ndttU 111x1 'generator'ab"economically practicable. '•'( 4 : <br /> ix th ve e'Ni fl, <br /> bind the above <br /> Retain sample# ed t t a <br /> • side of this form. <br /> LWOOTANT-:XQ']•"ICE kEGARD.ING THE DISPOSTI'ION OF Y6til..6I[. <br /> per California H ith and Safety Codei.gecEltoil 7k-S&9,Eveitgreen hoieby advises customer thga custo�riei:s.sbipa <br /> t�IgGls C <br /> tans aci that is reqult�;tov'o'tn Ip'With federal regulations applicable to mariagep-entr dV;A dN• k. .. •• : ) .'r;;; <br /> comp/ ith the more tringent retl>�iremehts:&pplxcable.to hazardotis:waste•managemesttfacities,Cal£oi{tii <br /> oil required to in se those more stringetftfiequrrements,and, out•of--state fAc ides that tro�`eas vsea�4 <br /> T se include mores ngent Iealc.detectioA'and prevention ilxjuirctxients,'ringineenng cernfcapons o �.... . <br /> ure and accident It' to'seild..used'ou to•out-6V'dtate facilities thhtconi-p13�-014 if ._:•., p, _ x <br /> cm n fteation.is'for:iafe%fafio uses' ss' <br /> d.not these mo u e ts.This nota u pulp a4I)C=; «:.:..: ; <br /> :., I <br /> nr;-,rvr C;(rnatllrP, print Name <br />