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e <br /> Evergreen Environmental Services N° 8 0 8 7 5 <br /> Containerized Services <br /> dedicated to the protection of the environment <br /> To schedule a pickup,call Send payment to: Sales Order# � ' <br /> 800-596-9455 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 j <br /> 1654()s.San Pedro st.,Carson,CA EPA#CAD982413262 Pasadena,CA 91I85-3234 Date: <br /> GEN ATOR/J B LOCATION BILLING INFORMATION <br /> NAA r NAME CASH[]CHECIL[� <br /> # <br /> SS ADDRESS ClWPAjER CODE NO. <br /> d� k <br /> CI STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> ONE NO. ,� r PHONE NO. PROFILE NO. 90 <br /> Olt4ER EPA ID NO. <br /> WASTE NIANIFEST <br /> PRODUCT CODE NUMBER QUANTITY UNITS PRICE ADSOC)NT <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Paint Related(Flammables oil based) <br /> Waste Paint Related(Flanunables oil based) <br /> Waste Aerosols Cans <br /> Kon-RCRA H—doas 11 m"solid iso". <br /> Ue6rrs<enLvninmed nii4 ctroltumhd,o.-mbou <br /> on-RCRA Hazmdeus wute.Solid(Soil. <br /> Dellistonnndnsted eidINILUIa A'dlacarMrSJ <br /> Waste Corrosive Liquids,n.o.s. <br /> Waste Flannnable 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 /> t 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 50150 <br /> Glycol Bulk Cone. <br /> TOTAL CHARGES <br /> TSDF <br /> ❑ Evergreen Oil,Inc. SA Recycling <br /> .6880SmithAve........... ..33210Western......... _._..........._....... _............. .. . ..................-................. <br /> .......... <br /> ... . . <br /> Newark,CA 94560 Union City,CA 94587 <br /> CAD980887418 CAL000344530 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: U Collecti011 Station ®Government quantity&toxicity of the hazardous waste to the degree detemtined by <br /> ®Matin Lj Agricultural ®Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have(he authority to <br /> bind the above listed generator to the terns on the reverse <br /> Retain sample# 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 /> oil are required to.meerthose m t-Jngent requirenents,and some out-of-state facilities that process used oil also meet those requirements. <br /> t.. These include amore stringent leak del tion and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> closure t1$nccidental releases.It is Ia��ful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> and these more stringent requirem t$ T 's 9 '949tion A for information purposes only. <br /> Driver SignaturePrint Name G ' <br /> Route# Date aerator s Signature P1tint Name l Date <br />