Laserfiche WebLink
�s <br /> / <br /> o <br /> Eves t�� �nvxx°��x exx al ,�er�rx�e N_ 72 4 <br /> Containerized Services <br /> dedimied to the protection of the environment <br /> To schedule a pickup,call Send Payment to: Sales Order# <br /> 000-596-9455 Evergreen Oil,Inc. <br /> 6880 Smith Are.,NeW'ark,CA L'PA//CAD982413262 Dept.LA 23234 <br /> 16540S.San Pedro St.,Carson,CA EPA//CAtD982413262 Pasadena,CA 91185-3234 Date: !� <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> ADDRESS <br /> IE , NAIVE CASH E]CHECK 11,116, <br /> ADDRESS CU OMER CODE NO. <br /> CITY STATE Zip CO. CITY SPATE ZIP CO. PO# <br /> h <br /> HO I.NO PHONE NO. PROFILE,NO. CUSTO\4ER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE <br /> CODE NUMBER An'IOUNT <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Paint Related(Flammables oil based) <br /> Waste Paint Related(Flammables oil based) <br /> Waste Aerosols Cans <br /> Ton-RCRA f1midous Waste,Solid((Boll, <br /> Drbrls nsntam)nattd ssith Roleum h d,ortrMns) <br /> Nsus-RCRA Haz rd-1Vutt,Saud ES <br /> uiI' <br /> u m <br /> Debris eo.unfl d arid, trokum h•drocarbons <br /> Waste Corrosive Liquids,n.o.s, <br /> Waste Flammable Liquids,n.o.s. <br /> Waste Flanunable 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 Water <br /> Non Hazardous Water <br /> Non Hazardous Solids <br /> Non Hazardous Solids <br /> Glycol Bulk 50/50 <br /> Glycol Bulk Cone. <br /> TOT L CHARGES <br /> TSDF _ <br /> EN-crgreen Oil,Inc. SA Rec cling <br /> ............................... yy ..................._..................,..._.............._.... .. .. .. ... .. ....... .. .. ............ <br /> 6880'SniilbAve. 332101Ve'stent <br /> Newark,CA 94560 Union City,CA 94587 <br /> CAD990887418 CAL000344530 <br /> rGenerator certifies that it has established a program to reduce the volume or SOIIrce: ®Collection Station 0 Government quantity,&toxicity of the hazardous waste to the degree determined by <br /> Lj Marine ® Agricultural ® Indushial generator to be economically practicable. <br /> fhereby certify that I have read and have the authority to <br /> Wild the above listed generator to the terms 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 hnzardous 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 more stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> closure and accidental releases.It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> and not these incp�stai tp uirentents.This notification is for information purposes only. <br /> fie <br /> Driver Signe ure Pr'rt Na e Route# Date Genera or's Sipn tura Print Name bate <br />