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Evergreen Eir )nmental Services .— Q 72969 <br /> Conta...erized'Services -, -.;. <br /> -.. .. ... dedicated to-the protection of the environment _ <br /> To schedule a pickup,call Send payment to: <br /> Sales older# <br /> 800-596-9455 <br /> 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 �j <br /> GENE ATOR/J B LOCATION BILLING INFORMATION Date <br /> gDRESS <br /> NAME <br /> E CASH❑CHECK❑ <br /> ADDRESS # <br /> CUST�R ODE NO. <br /> STATE Z CO. CPTY> STATE ZIP CO. PO# <br /> _ PHONE NO. <br /> PROFILE NO. STOMFR EPA M NO. <br /> ( ) <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 /> Nom-RCRA Hazardous Waste,Solid(Soil, — -- —_ —' <br /> Debris contaminated with petroleum hydrocarbons) <br /> Non CRA liozardous W"le.Solid(Sod, "--i— -'--- __ <br /> Debris contemimted with troleum h---carbons) .-- ... <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 Oxidizing Liquids or Solids G <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 /> TSDF TOTAL CHARGES <br /> Evergreen Oil,Inc. SA Recycling <br /> 6880 Smith Ave. ❑ 33210 Western <br /> Newark,CA 94560 Union City,CA 94587 z <br /> CAD980887418 CAL000344530 <br /> Source: ❑ Collection Station ❑GovernmentGenerator certifies 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 ❑ II1dusUW generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> Retain sample# i 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 /> Th ore stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> -sure and acci nta]releases.It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> and not these mor stringent requirements.This notification is for information purposes only. <br />