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j Evergreen EnviiMmental Services <br />Cothe pro Sen -ices the en <br />clediccNed to the pratrc•tinn n% the ernvrrunntent <br />To schedule a pickup, call Send payment to:. <br />800-596-9455 Ererereen Oil. Inc. <br />6880 Smith Ave., Newark, CA EPA# CAD982413262 P.O.- BOX 30517 <br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Los Angeles, CA 90030-0517 <br />GENE1.ATOR/JOB LOCATION BILLING INFORMATION <br />No 29693 <br />�Z <br />Sales r err# <br /># <br />Date: <br />NW11 <br />PRICE AAfOUN"T <br />N'AME <br />CASH CHECK E] <br /># <br />DR !. _ <br />v <br />ADDRESS <br />Waste Paint Related (Flammables oil based) <br />CU O IERXOD E <br />f <br />CIT ' <br />�.-ZIP CO. <br />CI1'1• <br />STATE ZIP CO. <br />P( # <br />PHONE NO. <br />1 ) <br />Waste Corrosive Liquids, n.o.s. <br />PHONE NO. <br />( 1 <br />Waste Flammable Liquids. n.o.s. <br />PROFILE NO. <br />CUSTOMER EPA ID NO. <br />WASTE MANIFEST <br />PRODUCT CODE NUMBER QUANTITY UNITS <br />PRICE AAfOUN"T <br />Waste Latex Paint (Non-RCRA) <br />Waste Latex Paint (Non-RCRA) <br />Waste Paint Related (Flanunables ail based) <br />Waste Paint Related (Flammables oil based) <br />Waste Aerosols Cans <br />RCR:A HaiarJou; ll, ', <br />Drhri. ennlaminan•J �ciih cvnlrum h�dn,cerhnn,� <br />\,m-RCRA Haranlouc \1':r.,c. SuliJ (Sod. <br />Dehri. rom:mrin:naJ aiih a•irolcwn Mdn.arhon.i <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 of 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 />r <br />71109 <br />TSDF <br />❑Eccrgrecn Oil. Inc. CFR ❑ <br />6880 Smith A%e. 3 X210 Western <br />Ne\cark. CA 9454 Union Citv. CA 94587 <br />CAD980887418 CAL0000C)1507 <br />TOTAL CHARGES <br />f <br />Generator certifies that it has established a pioumin rt/ reduce the \plume or <br />Source: ❑ Collection Station ❑ Government quantify & toxicity of the lizi/mdous \caste to the degree determined b� <br />❑ <br />Marine ❑ Acll-ICIItuPal ❑ IndtlStrfal Venerator to be economically practicable. <br />I hereby certify that I have read and have the authority to <br />hind the above listed generator to the terms on the reverse <br />Retain sample # side of this form. <br />IMPORTANT NOTICE REGARDING THE DISPOSITION OF POUR OIL. <br />Per California Health and Safety Code Section 25250.9, E\ererecn hereb\ ad\ iSeS Costumer that CUStonlCr'S Shipment Of used Oil ma\ he <br />transported to it Facility that is required to Comply \6th fcCleral re�.'ulilt ions applicable to management Of used roil. but that i, 1101 required u\ <br />•111)1\ \cith the more Stringent regttirenlentS appliCable to haZard0t11, \\aSte nrtnagenlent facilities. California faCilitie, that handle Or prOCeSs used <br />re required to meet those more Sarin lent rzyuirementS. and sumrout-91`-State facilities that process used Oil also meet those requirementS. <br />;e includC more stringent leak detection and Pre\ention requirement,. engineering, certifications of tank intelrit\. ant finanCial asSurtnCeS for <br />-0sLIN and accidental refeases. It is la\vful to ,end used oil tO Out -of -State facilities that comply onl\\\ith fcCleral used oil management stalldardS <br />and not these mo" stringent rCquirements. This notification i, lit ' ifOrmation purposes unlN. <br />�J <br />ll.•;, �r C;,,nnrri,•a Prinz TxToma RnnrN Tlota (;anars\tnr'c Cianatnrr= Print N'lllle I)ntt'. <br />