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e <br /> Evergreen Er 1�1 ��n� I �>"v' �� <br /> Con. __.erized Services ���� � — 7 2 <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Sendn ayment to: <br /> 800-596-9455 Sales Order# �e <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Evergreen Oil,Inc. <br /> ep.LA 2323 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD98241.3''-t;2. PasadenatCA 118543234 s <br /> NANERATOR/JOB OCATIO— N _ Date: <br /> BILLING INFORMATION <br /> NAME <br /> ADDRESS CASH Q CHECK(� <br /> ADDRESS— # <br /> CITY OUST MER DE NO. <br /> STA ZIP CO. CITY ✓ <br /> STATE ZIP CO. PO# <br /> PHO N <br /> ' _ <br /> (HO O PROFILE NO. <br /> CU TOMER EPA IDq�NO. <br /> PRODUCT WASTE MANIFEST <br /> COM NUMBER QUANTITY UNITS PRICE <br /> Waste Latex Paint(Non-RCRA) —�—� -'- AMOUNT <br /> Waste Latex Paint(Non-RCRA) - <br /> _._ <br /> Waste Paint Related(Flammables oil - <br /> Waste Paint Related(Flammables oil bas t — - <br /> l/ Waste Aerosols Cans" <br /> Non-RCRA Hazardous Waste,Solidi------- <br /> on-RDebris contaminattd with petroleum hydmcartgnU ?' _ - - <br /> i <br /> Non-RCRA Hazprdous waste,Solid(Sot), - -- 'l ..j•--1 i✓ �y <br /> Debns amtatninated will,tretroleim hvdiG�rhons) �- --• � �� -- <br /> Waste Corrosive Liquids,n.os, t <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 /> Non Hazardous Sole <br /> Non Hazardous Solids - <br /> Glycol Bulls 50/50 -— <br /> Glycq ulk Conc. <br /> TSDF — - TOTAL CHARGES <br /> Evergreen g een Oil,Inc. <br /> 3 Re <br /> T <br /> 6880 Smith Ave. 3cycling . <br /> Newark,CA 94560 Union <br /> 10 Western , A <br /> CAD980887418 Union City,CA 94587 <br /> CAL000.344530 <br /> Source: ® Collection Station Govemi Inti-_ __ <br /> Generator ceni.�s-,hat it has established a program to reduce the volume or <br /> Marine ❑ Agricultural quantity&toxicity of the hazardous waste to the degree determined by i <br /> InduSt6al generator to be economically practicable. j <br /> I her._— ebv_certify that I have read and have the authority t0 <br /> Retain S2Il1 pDe# bind the above listed enerator to the terms on_the reverse <br /> -- - side of this form <br /> IMPORTANT NOTICE FEGARDING THE DISPOSITION OF I'OUR 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 requd meet those more stringent requirand <br /> pr ventio,and some out-of-state facilities that process used oil also meet those requirements. <br /> hese include mo stringent leaf:detection and prevention re requirements enQ <br /> closure and accide tal rete s.It is lawful to send used oil to out-of-state facilities that comply only with federal used q gineering certifications of tank integrity,and financial assurances for <br /> and not thes s sent requirements.This notification is for information purposes only. I` <br /> ed oi]management standards <br />