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Evergreen Environmental Services N° 69398 <br /> Containerized Services <br /> dedicated to the protection of the enrlromnent <br /> To schedule a pickup,call Send payment to: <br /> 800-596-9455 Sales'Order# <br /> Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept,LA 23234 <br /> 16540 S.Snn Pedro St„Carson,CA EPA#CAD9824137-62 Pasadena,CA 91185-3234 Date: ' <br /> GENE,RATOR/JOB LOCATION BILLING INF ORNIATION <br /> NAR ,7 NAME <br /> CASH Q CHECK F] <br /> ADDRESS ADDRESS CT AIER CODE NO. <br /> CITY4 <br /> STATE Z[P CO CITY STATE ZIP CO. PO# <br /> F, <br /> P O NO. 8 PHONE NO. PROFILE NO. CUSTOMER EPA ID NO, <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Waste.Latex Paint(Non-RCRA) <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Paint Related(Flammables oil based) <br /> tiVaste Paint Related(Flamnlables oil based) <br /> Waste Aerosols Cans <br /> Noa-RCRA Hazardous\t�s1e,Solid((Soil, <br /> Debris consaOwed with smltamh drxa,buns! <br /> Non•RCRA Hoodoos R'astr,Soli)(Boll, <br /> Abrin rc*1t5miaaled wish trokum 6 Usoc ban <br /> Waste Corrosive Liquids,n.o.s. <br /> Waste Flammable Liquids,n.o.s. <br /> Waste Flammable Liquids,n.o.s. <br /> Non-RCRA Hazardous Neste,Liquid <br /> Non-RCRA Hazardous Waste,Liquid <br /> l Waste Toxic Liquids or Solids(Class(9) <br /> Waste,Oxidizing Liquids or Solids <br /> Drained Used Oil Filters <br /> Empty Drums 4 <br /> Non Hazardous Nater <br /> Non Hazardous Water <br /> Non Hazardous Solids <br /> Non Hazardous Solids <br /> Glycol Bulk 50/50 <br /> Glycol Bulk Cone. <br /> I <br /> TSDF TOTAL CHARGES <br /> Evergreen Oil,Inc. SA Recycling ❑ h <br /> U 6880 Smith Ave. 33210 NVestern <br /> ..............................Newark;CA 94560......... ....Union City.CA 94587................. ............ .. .......- ...................... .... `(J� L� t ! <br /> CAD980887418 CAL000344530 <br /> Genrator certifies that it has established a program to reduce the volume or <br /> Source: D Collection Statt011 ®Govellunent <br /> quaentity&toxicity of the hazardous waste to the degree determined by � <br /> ®Matine ®AgdCUltllral ®I11d11S(Zlal generator to be economically practicable. <br /> hereby certify that I have read alld have the authority to <br /> Retain Sample# bad the above listed ger ffator to the terns on the everse � <br /> side of this form <br /> IMPORTANT NOTICE REGARDING THE DISPOSITION Or 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 afacility that is required to comply with federal regulations applicable to management of used oil,but that is not required to <br /> :ompiy with the more stringent requirements applicable to hazardous waste management facilities.California facilities that handle or process used <br /> and <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 stria eat leak detection prevention requirements,engineering certifications of tank integrity,and finaticial assurances for <br /> Closure and accidental eases.It is lawful to send used oil to out-of-state.facilities that comply only with federal used oil management standards <br /> and not th a string nt requirements,This notification is for information purposes only. <br /> Driver Signature Print Name Route# Date Generator's ienaturre Print Natp I�atP <br /> I <br />