Laserfiche WebLink
12 69574 <br /> Evergreen vi ental Services - <br /> Containerized Services <br /> dedicated to the protection of the environment <br /> To schedule a pickup,call Send payment to: Sales Order# &,3y 71 <br /> 800-596-9455 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NA � <br /> NAME CASH❑CHECK <br /> /farms # <br /> ADDRES-S ADDRESS CUSTOMER CODE NO. <br /> CITY STATE —ZIP CITY STATE ZIP CO. PO# <br /> 47 <br /> PLIONE NO. ��- PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <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 /> Non-RCRA Hazardous Waste,Solid(Soil, <br /> Debris contaminated with [role ro hydrocarbons)) <br /> Non-RCRA Hazardous Waste,Solid(Soil, <br /> Debris contaminated with troleum hydrocarbons <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 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 50150 <br /> Glycol Bulk Cone. <br /> TOTAL CHARGES <br /> TSDF <br /> ,Evergreen Oil,Inc. SA Recycling <br /> 880 Smith Ave. ❑ 33210 Western ❑ •- <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: ❑ Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑ Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I herebycertify ertify that I have read and have the authority to <br /> bind 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 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 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 t stringent requirements.This notification is for information purposes only. <br /> ilrivPr.Cianntttra Print Nama P—fa fF Tl,fo o.e r, ... r)»: <br />