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0 <br /> 0 1` h <br /> JPQ. Evergi eYa alvi oaa �aa��� c vYccs d 9,�d <br /> Containerized Services <br /> deelicated to dre p)olecdon gfthe a t,hornnenl <br /> To schedule a pickup,call Send payment to: Sales Qrder# <br /> 800-972-5284 W-7 <br /> Evergreen Oil,Inc. <br /> 6880 SnikhAve.,Newark,CA EPA#CAD982413262 Dept.LA 23234 r� <br /> 16540S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date. ." a _�J <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> N IEj—1ZNAR4E CASH❑CHECK <br /> AD RE,SSf ;r/ <br /> ADDRESS C�j1,ST M A D E NO. <br /> CITY SAE 7IP CO. CITY STATE ZIP CO. PO# <br /> �-� ' CI, <br /> P NT r0. PHONE 1Y0. PROI+ILE NO, CUSTOMER EPA ID N0. <br /> PRODUCT WASTE MANIMT QUANTITY UNITS PRICE <br /> CODE NUMBER AMOUNT <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Latex Pairit(Non-RCRA) <br /> Waste Paint Related(Flammables oil based) <br /> Waste Paint Related(Flaturnables oil based) <br /> Waste Aerosols Cans <br /> ..•RCRA Hazsrdru waste,solid((Soo, <br /> DebAsmilmAn.sled ssrtb tm*umh? .1,o.s <br /> Neo-RCRA Hatardous\Yasie,Solid(Soil, <br /> Debris toaWminztcd wish troteum h�rotarhons) <br /> Waste Corrosive Liquids,n.o.s. <br /> Waste Flammable Liquids,11.03. <br /> Waste Flammable Liquids,11.0.3, <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 Water <br /> Non Hazardous Water <br /> Non Hazardous Solids <br /> Non Hazardous Solids <br /> Glycol Bulk 50/50 <br /> Glycol Bulk Cone. i <br /> r <br /> TSDF TOTAL CHARGES <br /> ❑ Evergreen oil,Inc, SA Recycling <br /> 6880 Smith Ave. 33210\restern ❑ <br /> �relvrtrk,CA 91560 ... ...._....Union.City,.CA.94S87................. ..__ _................_ <br /> . .._.... ........ ...... .. .. ......................................................... ......_....... <br /> CAD980887418 CAL000344530 <br /> S0111-Ce: ®Collection Station ❑Govelllment Gcaerator certifies that it has established a program to reduce Utc volume or <br /> quantity&toxicity of the hazardous waste to the degree determined by <br /> ®Malllle ®i�gl'iCUitUI'al ❑Iudustliap generator to be economically practicable. <br /> I hereby certify that I have read and have the autltorily to <br /> Retain samplebind the above listed generator to the terms on the rover c <br /> side of this form. f <br /> IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. II <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 j <br /> comply with the more stringent requirements applicable to hazardous waste management facilities.California facilities that handle or process used <br /> I are required to meet those more stringent requirements,and some out-of-state facilities that process used oil also meet those requirements. <br /> hese include more strin-eat k detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> closure and ac etrtat re eases.It is ul to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> and no a more stringent requirem ts.T ' no' ati is for information purposes only. I <br /> Driver Signature Print Name Route# Date Generator' ignatur Print Nal a Date j <br />