Laserfiche WebLink
l <br /> Evergreen Environmental Services 95349 <br /> Containerized Services <br /> dedicated to the plvtection of tine environment <br /> To schedule a pickup,call Seud payment to: Sales Order# <br /> 800-972-5284 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 <br /> 16540 S.San Pedro SL,Carson•CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: <br /> GENERATOR/JOB LOCATION BILLING INI!ORMATION <br /> NAME — NAME CASHE]CHECK(] <br /> ADDRESS ADDRESS CUSTOMER CODE NO. <br /> CITY STAT IP CO. CITY STATE ZIP CO. PO# <br /> PHONE NO. PHONE N0. PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE <br /> CODE NUMBER AMOUNT <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Paint Related(Flammables oil based) <br /> Waste Paint Related(Plammables oil based) <br /> Waste Aerosols Cans <br /> NDn•RCRAHa J.as 15'asta.Solid(Soil, <br /> Debris conlsnstn ud adrh icaleam �drpcarbons) <br /> Non'MRA H.—dans))'asla,Solid{Boll, <br /> Debrrs coNandnstn3 xith Ua4umh dra arbors <br /> Waste Corrosive Liquids,n.o.s. <br /> Waste Flammable Liquids,mo,s. <br /> Waste Flammable Liquids,n.o.s. <br /> Non-RCRA Hazardous Waste,Liquid <br /> Non-RCRA Hazardous Waste,Liquid I <br /> Waste Toxic Liquids or Solids(Class 9) <br /> Waste Oxidizing Liquids or Solids <br /> Drained Used Oil Fitters <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 /> TOTAL CHARGES <br /> TSDF <br /> Evergreen Oil,Inc. SA Re I' <br /> ❑ 6880SmithAvo:..._..... ....33210l�restern..............a............. . ...........,....... ......_.._........................_.................................................. .. ................._............_.............. ...................._........., <br /> Newark,CA 94560 Union City,CA 94587 <br /> CAD980887418 CAL000344530 <br /> SGurCe: ® C011eCt1011 Station ®GGvernment Generator certifies that it has established a program to reduce the volume or i <br /> quantity&toxicity of the hazardous waste to the degree determined by <br /> ®Ma12ne ® Agricultural ®Industrial generator to be economically practicable. <br /> I hereby cert[fy that I have read and have the authority to <br /> bind the above listed generator to the.terms on the reverse <br /> Retails sample# slde of this form. • t <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 /> These include = gent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for j <br /> closure accidental r teases.It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> and t these more stri gent requirements.This notification is for information purposes only, <br /> Driver Signature Print Name Route# Date Generator's Signa re Print Name Date <br />