Laserfiche WebLink
Lv a tvi ental Services <br />Containerized Services <br />V <br />dedicated to the p on of the environment <br />-4v To schedule a picicall <br />Send payment to <br />800-.596-9455 <br />Evergreen Oil, Inc. <br />6880 Smith Ave., Newark, CA EPA# CAD982413262 <br />Dept. LA 23234 <br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 <br />Pasadena, CA 91185-3234 <br />GENERATOR/jOB LOCATION <br />BILLING INFORMATION <br />N " m <br />NAME <br />AD KESS <br />ADDRESS <br />CITY STATE ZIP CO. <br />CITY STATE ZIP <br />PHO N,, <br />PHONE NO. <br />PROFILE l <br />PRODUCT <br />WASTE <br />CODE <br />MANIFEST <br />NUMBER <br />QUANTTTY <br />UNITS <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 />Waste Corrosive Liquids, n.o.s. <br />Waste Flammable 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 <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 50150 <br />Glycol Bulk Conc. <br />TSDF <br />Evergreen Oil, Inc. (SSA Recycling ❑ <br />6880 Smith Ave. L 33210 Western <br />ewazk, CA 94560 / `Union City; CA 94587 <br />CAD980887418 CAL000344530 <br />Sales Order # <br />Dater <br />CASH F] CHECK <br />PRICE I AMOUNT <br />TOTAL, CHARGES <br />®Government Generator certifies that it has established a program to reduce the volume or <br />Source: ❑Collection Station <br />quantity & toxicity of the hazardous waste to the degree determined by <br />❑ Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br />I hereby certify that I have read and have the authority to <br />Retain sample # bind the above Iisted generator to the terms on the reverse <br />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 meet those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements. <br />These include nt leak detection and prevention requirements, engineering certifications of tank integrity, and finciai assurances for <br />closure tr8 accidental relea s. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br />Lof these more stringent quirements. This notification is for information purposes only. <br />Driver Sit ature Print Name Route # Date Generator's Silrna urePrint a -e bate <br />