Laserfiche WebLink
Evergreen Env' -nmental Services <br /> Contal_-_ized Services N 8 0 5 9 5 <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: <br /> - 800-596-9455 EvergreenOilsales order# <br /> - -- - — -- <br /> ,Inc.--- <br /> -:, <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: 4 �` <br /> GENERATOR/JOB LOCATION _ BILLING INFORMATION <br /> NAME NAME <br /> J f�f,V� CASH n CHECK E] <br /> ADDRESS ADDRESS # <br /> CUSTOMER CODE NO. <br /> CITY STATE IP CO. CITY <br /> _ � STATE ZIP CO. PO# <br /> PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> tow '(:Q$7F ) <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS 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 /> -- -- - - <br /> Non-RCRA Hay rdous Waeta Solid(Soil, .. . ........—_.•.--�. ----.--__.� ._._. <br /> Debris conrartuna,r�l:,�i[h p tR,leun:hydrocarbons) <br /> — — <br /> —__ <br /> Non-RCfGt Har.Mrnts Waste.Solid(Soil, "`""`-- '- - — <br /> Debris contaminated with petroleum bydrocarbons) - .—`-. --- --- -- - -— — <br /> aste Corrosive Liquids,n.o.s. <br /> -- <br /> Waste Flammable Liquids,n.o.s. <br /> Waste Flammable Liquids,n.o.s. ---- --- - —_ <br /> Non-RCRA Hazardous Waste,Liquid I - -- — <br /> Non-RCRA Hazardous Waste,Liquid i —— --- - <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 /> - ------- ---- <br /> Non Hazardous Solids - -- -- -- <br /> Non Hazardous Solids -- <br /> Glycol Bulk 50150 _ Y <br /> Glycol Bulk Conc. - -- - -"" - — - -- <br /> TSDF -- <br /> TOTAL CHARGES <br /> ,r <br /> ❑ Evergreen Oil,Inc. SA Recycling <br /> 6880 Smith Ave. ❑ 33210 Western <br /> Newark,CA 94560 Union City,CA 94587 __ <br /> CAD980887418 CAL000344530_ _ <br /> Source: ❑ Collection Station ❑Gatremmei±t Ge�era`t6r certifie that it has established a program to reduce the volun;e or <br /> quantity&toxicity of the hazardous waste to the degree detennined by I <br /> ❑ Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> Retain sample# bind the above listed generator to the terms on the reverse <br /> — 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 range leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> closure ccidental rele ses.It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> and these more st ' nt requirements.This notification is for information purposes only. <br /> Driver Cinnattrra D,;-+ kT___ 7 <br />