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Evergreen �+nvironniental Services 2 95491 <br /> Containerized Services <br /> dedicated to the ptvteciior of rhe ent,irarrreltt <br /> To schedule a pickup,call Send payment to: Sales Order# �' <br /> 800-972-5284 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Kew,rk,CA EPA#CAD982413262 Dept.LA 23234 <br /> i 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: <br /> GENE,RATOR/JOB LOCA'T'ION BILLING INFORMATION <br /> NAME NAME CASH n CHECK(] <br /> ADDRESS t t # <br /> ® ADDRESS CUSTOMER CODE NO. <br /> CIT A1'E ZIP CO. CITY STATE ZIP CO. PO <br /> P NE 0, PHONE NO. PROFILE NO, CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Paint Related(Flanrntables oil based) <br /> Waste Paint Related(Flarnrnables oil based) <br /> Waste Aerosols Cans <br /> Non-RCRA Hazvdoos Wmle,Solid(Soil• <br /> ocbris rontaminottd with •daeatbans <br /> Non-RCRA Hazardous <br /> t w".Solid(Soil• <br /> ' ncbdf centunimm�i.stdr tmfeumh dmcmbons , <br /> Waste Corrosive Liquids,n.o.s. <br /> 1Vaste Flanunabte Liquids,n.o.s. <br /> Waste Plamniable Liquids,n.o.s. <br /> Non•RCRA Hazardous 1Vaste,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 Water <br /> i <br /> Non Hazardous Water <br /> Non Hazardous Solids <br /> Non Hazardous Solids <br /> Glycol Bulk 50150 <br /> Glycol Bulk Conn. <br /> TSDF TOTAL CHARGES <br /> Evergreen Oil,inc. SA Re 1i <br /> 6880 Smith Ave:--- ...... 332101Vestern..... :....0....._........_.... ....__..-........-..... ... ......................................:.... ............ . ..............................,... ..- <br /> Newark,CA 94560 Union City,CA 94587 <br /> CAD980887418 CAIM0344530 <br /> Source: Q Collection Station ❑GOVernillent Genciator 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 /> Q Marine Q Agricultural ®Iiiduslitial generator to be economically practicable. <br /> I lterehy cera ft that I have read and have the authority to <br /> Retain sample# bind the above i m <br /> t d generator to the terms on file 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 /> ail are required to meet those more stringent requirements,and some out-of-state facilities that process used oil also meet those requirements, <br /> liese <br /> jacl a more s ringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> ItsTe and accident rel es,Itt�t''s Iawful to send used oil to out-of-state facilities that comply only with federal used oil management standards I <br /> not these mor uirements.This notification is for information purposes only. <br /> q .dv <br /> Driver Signature Print Name Route# Data GenerOor'—sSikgnature Print Name bate <br />