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Evergreen Envie )m -ental Services <br />Container7z'ed Services <br />An dedicated to the pmrect%on of thi, envirortmem <br />To schedule a pickup, call Send payment to: Sales Order # G� % <br />800-596-94.55 Evergreen Oil, inc. <br />"81) Snaith Ave.. Nuwnrk. CA r;PA# CA0982417262 Dept. LA 23234 <br />I0540C. Cin P*dm Ct., C:nrMn, CA F..PA# CAD932413262 Pasadena. CA 91185-3234 Date: <br />r-vwTviDe•r•ntarrnn a nt-e•r°TAIV T2TT.T.TN[_ TNVARMATTnN <br />PRODUCT WASTE MANWEST QUANTITY UNITS <br />CODE NUMBER <br />PRICE AMOUNT <br />NAME <br />CASH [] CRECK <br />Waste Paint Related (Flammable oil based)' <br />Wasic Paint Related (Flammublos oil bused) <br />ADDRESS <br />ADDRESS <br />CUSTOMPR CODE NO. <br />Wk%te Corrosive Liquids. n.o.s, <br />WQ5ac; Fl, mrnablc Liquids, <br />CI I� STATE <br />r ''/,IP .O- <br />CiTY <br />STATE ZIP CO. <br />PO # <br />Non.RCRA 1•In%ardnuc wz%ta, Liquid <br />Wuste Toxic Liquids or Solids (Class 9) <br />waste Oxidizing Liquids or Solids <br />PRONE NO_ <br />Drained Used Oil tiller,: <br />PHONE NO. <br />Empty Drums <br />PROFILE NO. <br />CUSTOMER EPA ID NO. <br />Non Malardovo Watcr <br />Non Htm•trdous Solids <br />Non Hazardous Solids <br />PRODUCT WASTE MANWEST QUANTITY UNITS <br />CODE NUMBER <br />PRICE AMOUNT <br />Waste Latex Paint (Non-RCRA) <br />Wasic TAlcx Pninr (Non-RCRA) <br />Waste Paint Related (Flammable oil based)' <br />Wasic Paint Related (Flammublos oil bused) <br />Wugte Aerosol. Cans <br />� nn Rf1N.4II:UarJ,w. wawa. Soup lS�al. <br />' Dehri, wncnmi,u�tep wish kamlewn hvJnxmhwc> <br />Nun-1W'kA rlar2ntnnR -.11M Mdid (S.J, <br />pchn.,conrunlnalM was 9ftltcum h Ilt.carlmml <br />Wk%te Corrosive Liquids. n.o.s, <br />WQ5ac; Fl, mrnablc Liquids, <br />Waste Flammable Liquids, n.o.s. <br />Non-RC1L•', Hazardous Waste. Liquid <br />Non.RCRA 1•In%ardnuc wz%ta, Liquid <br />Wuste Toxic Liquids or Solids (Class 9) <br />waste Oxidizing Liquids or Solids <br />Drained Used Oil tiller,: <br />� <br />Empty Drums <br />Non tiozirdouc Wow <br />Non Malardovo Watcr <br />Non Htm•trdous Solids <br />Non Hazardous Solids <br />Glycol Bulk 50150 <br />Glycol Bulk Cone. <br />TSDF <br />❑rvcrrrccn Oil. inc. SA Recycling�— <br />6830 Smith Ave, 33210 Western <br />Ncwark, CA 94560 Union City, CA 94587 <br />TOTAL CH OES <br />Source_ ❑ Collection Station ❑ Grovemment <br />❑ Marine ❑ Agricultul:al ❑ Industrial <br />Retain sample # <br />Generator ccrtifics that it hag eM1*li$hed a prof ratn to reduce the volume or <br />quantity a& toxicity of the hazardous wastc to aha dcgrv. determined by <br />generator to be economically practicable. <br />I hereiey_certify th1t.. )1Ayr. 4wA. nd have the authority co <br />hind theabove_LiJ[gd RG1C1tQr to the terms on the revercq <br />side of this form. <br />IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OM <br />Per California Health and Safety Code Section 25250.9. Evcrymen hereby advises customer that customer's sltipntent of used oil may he <br />transported to a facility that is required to comply with federal regulations applicable to management of used oil. but that is slot attired 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 ;list) meet those requirements. <br />These include more stringent leak detection and prevention requirements, engineering certifications of tank integrity. and Financial assurances for <br />closure: t(nd accidental rolcwes. 1•t is lawful to send used oil to out-of-state facilities that comply only with rederal used oil management standards <br />and not these snore-stringent-requircments. This notification is for infoirnation purposes only. <br />�-fr,d,.. -� ,i� ova -^-r` � '" � /f t � lc ��• i - i % <br />•n..:.._.. r: .__...��••'-"n..: t....... / v ...... , !/ rl•,rn (:.•r��rarnr'aPCi,•rnntnrr•• Prim Minto — fiat,•' <br />X00 'd Nd I5 : z I CSM I I oz-oz-1flr <br />