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i <br /> Evergreen E 'ronmental Services N° 81870 <br /> Comainerized Services <br /> dedicated to the protection of the environment <br /> To schedule a pickup,call Send payment to: Sales Order# <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 Date: ! <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NAM — NAME CASH CHECK <br /> Z # <br /> AD RES S ADDRESS CUST MER CODE NO. <br /> I Y SAE �Wd'l. CITY STATE ZIP CO. PO# <br /> PHONE/PR. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <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 Heznrdous Waste,Solid(Soil, <br /> Debris rnnmminated with uoleum h dmcarbons) <br /> Non-RCRA Hazardous Waste,Solid(Soil, <br /> Debris contaminated with t;Ium h dtncarbons <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 /> 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 50/50 <br /> Glycol Bulk Conc. ' <br /> 193<L CHARGES <br /> TSDF <br /> ❑ Evergreen Oil,Inc. SA Recycling <br /> 6880 Smith Ave. 33210 Western <br /> Newark,CA 94560 Union City,CA 94587 <br /> CAD980887418 CAL000344530 <br /> Generator certifies that it has established a program to reduce the volume or <br /> • Source: ❑ Collection Station ❑Government 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 /> comply with the more stringent requirements applicable to hazardous waste management facilities.California facilities that handle or process us( <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 n e tection and prevention requirements,engineering certifications of tank integrity,and financial assurances fol <br /> closur accidental releases. It i awful to send used oil to out-of-state facilities that comply only with federal used oil management standard! <br /> a not these more stringent re emen i no- cation is for information purposes only. <br /> - s <br /> T f.• _. 11 .. 1.T. .. T___._ 1[ T_-_ /�_.____a_..) -_._� _._ T_�.-a AT_,__ T\_._ <br />