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Nix <br /> WHOM <br /> . x� , <br /> `Te Mn-mental Services <br /> n <br /> 'Contam erized 'Senrce5 „ ,� <br /> OF, <br /> rledlcated to the protection o{rJte envW <br /> ^;� � it r •�d ^wr <br /> To schedule a pickup, call send payment to: <br /> "(� Q <br /> '"455 Evergreen 0i1.Inc. sales Order# <br /> �0�'S"Q <br /> 6,"0 Smith Avc_Newark.CA EPA# EA 23234 <br /> 540 S.San Pedro St.,GENERATOR/ OB LOCATION <br /> CA EPAifi cAD982413262 Pasadena,CA <br /> CAD982413262 Dept.L <br /> 91185-3234 Date:_�/ <br /> _ J OCATION BILLING INFORMATION <br /> NAGE, � <br /> CASH:[]CHECK <br /> ADDRESS �y ~ ADDRESS # <br /> J _ C NO. <br /> CITY STATZIP CO. (ITY STATE ZIP <br /> CO. 0# <br /> �Y�-- <br /> �� PHONE NO. <br /> PROF -E NO. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE-MANIFEST <br /> CODE NUMBER QUAN'T'ITY UMTS PRICE AMOUNT <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Paint-Related <br /> (Fia,nmables-oil based) <br /> Waste Paint Related -- <br /> (Flammables oil based) `' -- <br /> Waste Aerosols Cans <br /> Non-RCRA Hazardous Waste,Solid(Soil, <br /> Debris con[aminmed wit�troleum hydrocarbons) --- <br /> Non-RCRA Humdous Waste.solid(Soil, - ----^--•--- _ _— i <br /> Debris contaminated with petrolmm h droearbons <br /> Waste Corrosive Liquids,mo.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 Fi)ters - ---- <br /> Non Hazardous Water <br /> Non Hazardous Water <br /> Non—Hazardous Solids <br /> Non Hazardous Solids <br /> Glycol Bulk 50/e.) -- <br /> Glycol Bulk Com:. l --` _— --- --- _ <br /> AV — <br /> TS F TOTAL CH GES <br /> Evergreen Oil,Inc. SA Recycling • / <br /> 6880 Smith Ave. LJ 33210 Western <br /> Newark,CA 94560 Union City,CA 94587 <br /> CAD980887418 CAL000344530 - <br /> SOUrce: ❑ Collection Station LJ Govemme l 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 Elrial Agricultural ❑Industgenerator to be economically practicable. <br /> - I hereby—certify that I have read and have the authority to <br /> Retain SH)m # 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 /> transporte a acili that is required to comply with federal regulations applicable to management of used oil,but that.is not required to <br /> comp] ith the more tringent requirements applicable to hazardous waste management facilities.California facilities that handle or process used <br /> oil required to mee those more stringent requirements,and some out-of-state facilities that process used oil also meet those requirements. <br /> se include mores ngent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> osure and accidents s.It is <br /> and to send used oil to out-of-state facilities that comply only with federal used oil management,standards <br /> not these mor i ui-rements.This notification is for infozination purposes only. ' <br />