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Evergreen Environmental Services <br />a Containerized Services <br />dedicated to the prosection of the em-hounrew <br />To schedule a pickup, call Send payment to: <br />800-596-9455 Evergreen Oil, Inc. <br />6880 Smi1h Ave., Ncwnrk, CA EPA# CAD982413262 Dept, LA 23234 <br />16540S. San Pedro St., Carson, CA EPA# CAU982413262 Pasadena, CA 91185-3234 <br />GENERATOR/JOB j,OCATION BILLING INFORMATION <br />N° 82497 <br />Sales Order�� <br />Date: Ur,� <br />NA ME1 <br />NAME <br />CASHEJ CIMCK ❑ <br />ClAe <br /># <br />ADMtE SS <br />ADDRESS <br />CU TOMER CODE NO. <br />C'�&2 A—� �' I Ilk - <br />B <br />C'I_Tj' STAIE, ZIP <br />CITY <br />STATE ZIP CO. <br />PO d <br />PITONF <br />PHONE NO. <br />PROFILE NO. <br />CUSTOIJER EPA ID N0. <br />_ <br />PRODUCT WASTE IlIANWEST QUANTITY UNITS PRICE Ar\IOUNT <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 (Flaniniables oil based) <br />Waste Aerosols Cans <br />�on-RCRA Haran o,m\'acre.So!i 1, of <br />D.tris ctvtamiealeJ pith . 1, h t'.K ns <br />N--RCRA alvardous mm acte, SNId (soil. <br />Dellis comaninaed with •uoleumh dro:artw�ns <br />Waste Corrosive Liquids, n.o.s. <br />Waste Flarntnable 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,fkr <br />EmPty Drums <br />Non Hazardous Water <br />Non Hazardous Water <br />Non Hazardous Solids <br />Non Hazardous Solids <br />Glycol Bulk 50!50 <br />Glycol Bulk Conc. <br />TOTAL CHARGES <br />TS r <br />Evergreen Oil, Inc. SA Recycling ❑ <br />6880 Smith Ave. 33210 Western <br />Newark. CA 94560 Union City, CA 94587 <br />CAD980887418 CAL000344530 <br />Generalorcertifies that it has established a progr in to reduce the volume or <br />Source: ❑ C011ectim Station ❑ Govennnent quantity & toxicity of the hazardous waste to the degree determined by <br />❑ Mmfiie ❑ Agricultural ❑ Indushial generator to be economically practicable. <br />I hereby certify (fiat I have read and have the authority (o <br />bind the above listed generator to the terms on the revers <br />Retain Sample # side of this f rill, <br />IMPORTANT NOTICE REGARDING THE DISPOSITION OF POUR OIL. <br />2-1 <br />Per California Health and Safety Code Section 25250.9, Evergreen hereby advises customer that customer's shipment of used oil map 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 snore 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 these gni ' g -e requirements. Tlds notification is for information purposes only, <br />Driver Signature Print Name Route # Date aerator' tgnattire Print Name Date <br />