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Evergreen Eng mmental Services - -. ��� 72968 <br /> 777. Conth__ Ozed-Services <br /> dedicated to.the protection of the:enviranment <br /> To schedule a pickup,-call Send payment to: <br /> 800-596-9455 Evergreen Oil,Inc. Sales.Order# �� �- C� <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234, <br /> 16540 S.San Pedro Sc,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-323+ �i°4` <br /> GENERATORIJOB OCATION Date: <br /> BILLING INFORMATION <br /> N NAME <br /> CASH El CHECK El <br /> ADDRESS ADDRESS if <br /> CUS MER ODE NO. <br /> CITY ST ZIP CO. CITY STATE ZIP CO. PO# <br /> PHO N ^ ' � �— <br /> PHONE NO. PROFILE NO. CU TOMER EPA IDNO. <br /> 7� !moi <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 /> GWaste Aerosols Cans <br /> Non-RCRA Hazardous Waste,Solid(Soil, — <br /> Debris contaminated with troleum h drocarbons) % f — <br /> No CRA Hamrdous Waste,Solid(Soil, f7 <br /> Debris ontaminated with troleum h rocarbons <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 /> e .ater <br /> Non Hazardous Solids <br /> Non Hazardous Solids <br /> Glycol Bulk 50150 <br /> Glyc ulk Conc. _ <br /> TSDF TOTAL CHARGES <br /> Evergreen Oil,Inc. SA Recycling / <br /> 6880 Smith Ave. � 33210 Western ,. C <br /> Newark,CA 94560 Union City,CA 94587 ' <br /> CAD980887418 CAL000344530 <br /> Source: ❑ Collection Station ❑Govem ent Generator certi ies that it has established a program to reduce the volume or <br /> 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 /> 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 /> of require meet those more stringent requirements,and some out-of-state facilities that process used oil also meet those requirements. <br /> hese include mo stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> closure and accide tal rele s.It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> and not thes s serif requirembnts.This notification is for information purposes only. <br />