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I <br /> Evergreen Env' �nmental Services N° 73002 <br /> Contai>___,zed Services <br /> dedicated to the protection of the environment <br /> To schedule a pickup,call .Send payment to: <br /> 800-596-9455 Sales Order# <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Evergreen <br /> LA023234c <br /> 16540 S.San Pedro.SL,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 <br /> GENERATOR/JOB LOCATION BILLING INFORMATION Date: <br /> nN <br /> — <br /> NAME <br /> CASH Q CHECK[] <br /> # <br /> CUSTOMER CODE NO. <br /> 71P CO. CCO. PO# <br /> PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT . WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Waste Latex Paint,"'Ton <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Paint Related(Flammables oil based) <br /> Waste Paint Related(Fiammables oil based) <br /> Waste Aerosols Cans – <br /> ,3 - <br /> Non-RCRA Hazardous Waste,Solid(Soil, - - -- -- --_ 0 <br /> Debris contaminated wiN stole i h droearbons) -- __ <br /> Non-RCRA Hazardous Waste,Solid(Soil, <br /> Debris coutamineted — <br /> Waste Corrosive Liquids,n.o.s. - – <br /> Waste Flammable Liquids,n.o.s. r <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 /> it F' !S <br /> Empty Drums — — <br /> Non Hazardous Water – <br /> Non Hazardous Water <br /> Non Hazardous Solids — <br /> Non Hazardous Solids - <br /> id r <br /> � s-- - <br /> �� .s'— <br /> TSDFvG?7 TOTAL CHARGES <br /> © Evergreen Oil,Inc. <Cg <br /> 6880 Smith Ave. 33 rnNewark,CA 94560U ' CA 94587CAD980887418 L00530 <br /> Source: ❑ Collection Station ❑Government Generator 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 ❑ Agncultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the author"o <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 an*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 tringent requirements applicable to hazardous waste management facilities.California facilities that handle or process used <br /> oil are re ' d to mee those more stringent requirements,and some out-of-state facilities that process used oil also meet those requirements. <br /> These' u mores ent leak detection and prevention requirements,engineering certifications of tank integrity,Vd financial assurances for <br /> cl re and accide rel ases.It is 1 1 to send used oil to out-of-state facilities that comply only with federal used'oil management standards <br /> d not these nt requ' ents.This notification is for information purposes only. <br /> �3_0n/ r <br />