Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
Evergreen Environmental Services N° 72380 <br /> Containerized Services <br /> dedicated to the protection of the environment <br /> To schedule a pickup,call Send payment to: Sales Order# <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 /> GENERAT,OW.IOB LOCATION BILLING INFORMATION <br /> NA NAME CASH CHECK E] <br /> CB # <br /> CUSTOM <br /> FMIOKENO. <br /> ' �_/j ADDRESS ER CODE NO. <br /> ST Ste/ CO. CITY STATE ZIP CO. PO# <br /> �^ /, PHONE NO. PROFILE NO. TOMEZ P I-7 / <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 /> Nom RCRA HamrJous w:pte,Soli)(Soil• <br /> DeM1ri+cnnt:nninntsvl with Irolcum h•JracnrM+nsl <br /> Nun-RCRA H�¢nNoos\Y:\ste,Sn1iJ(Buil, <br /> Ih$ris ttnuamin:ned with tmleum h ronulwnx <br /> Waste Corrosive Liquids,n.o.s. <br /> Waste Flammable Liquids,n.o.s. 21 <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 14 <br /> i <br /> Empty Drums <br /> Non Hazardous ater <br /> idon Hazardous Water <br /> Non Hazardous Solids _ <br /> Non Hazardous Solids <br /> Glycol Bulk 50/50 <br /> G ycol Bulk Conc. m <br /> i <br /> TOTAL CHARGES <br /> TSDF _ <br /> Oil�aEvergreen Oil,Inc. ❑ SA Recycling <br /> 6880 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 volulne or <br /> Source: El Collection Station LJ Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑ Marine L] Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify that I have Lead 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 a• "leases.It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> and I ese more swinger •equirements.This notification is for information purposes only. <br /> e <br /> Driver Ci ntnrp. Pr' t Name Route# Date Generator's Signature Print Name Date <br />