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A <br /> Alk <br /> 1a0v <br /> 5 Evergreen Envilimental Servicesyo �' ' $ $ <br /> Containerized Services ���dedicated to the protection of the environment <br /> To schedule a pickup,call Send payment to: <br /> Sales Order # <br /> 800-596-9455 Evergreen 0i1;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 Date: i <br /> G RATOR/JOB LOCATION BILLING INP TION <br /> E NAME <br /> &HONO.. <br /> CASH� CHECK <br /> ADDRESS # <br /> STATIP CITY 'E P # <br /> i ?/O PHONE NO. / PR F'H,E 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 /> N..-R Huallous Wine,Solid(Soil, <br /> I OU'K ennumm.. ww leum h a.oe.mon: <br /> Dobmbra..A Hanrdous Wane,Saari(Soil, <br /> DenuminaW wiN wleum h mc.dgns <br /> Waste Corrosive Liquids,n.o.s. <br /> Waste Flammable Liquids,n.os. <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 'ds <br /> Drained Used Oil <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 Q <br /> Evergreen Oil,Inc. CFR ❑ <br /> 6880:Smith Ave. 33210 Western <br /> Newark,CA 9 60 - Union City,CA 94587 <br /> CAD980887 8 CAL000091507 <br /> Source: El Collection Station Ll Government Generator certifies that it has established a program to reduce the volume or <br /> quantity&toxicity of the hazardous waste to the degree determined by <br /> []Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify 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 rel ases. 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 more s ' nt requirements. This notification is for information purposes only. <br /> L-_2fCir/S t� S C'1�77 <br /> n«:..., c:......«..«., n«:.,. >,r,,...,, n,....., 4 n«:... 1.r,.,,a r)oro <br />