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N-0 <br /> �j Evergreen Envi nmental Services <br /> 1� 9169 <br /> Containerized Services <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: <br /> Sales Order <br /> n 800-972-5284 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: 8'-ZZ%? <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> .NAME NAME CASH❑CHECK❑ <br /> s # <br /> ADDRESS ADDRESS CUSTOMER CODE NO. <br /> 9 r• -57Au496,/ <br /> CITY STATE ZIPS CO. CITY STATE ZIP CO. PO# <br /> C$ fs-AP <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA B)NO. <br /> ( ) <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> - <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Paint Related(F'lammables oil based) <br /> Waste Paint Related(Flammables oil based) - - <br /> Waste Aerosols Cans <br /> Non-RCRA Hn OUS WNW Solid(Soil, ' <br /> Dbds conlaminn¢d wjdi Nood..b rocubon <br /> Non-RCRA Hai don Wwo,Solid(Soil, <br /> n br..conuminwi widN .I..b .ambo. <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 or Solids <br /> Drained Used Oil Filters G <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 Cone. <br /> TOTAL CHARGES <br /> TSDF <br /> ❑ Evergreen 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 volume or <br /> Source: ❑ Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> L] 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 shipmentof 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 /> � mply with the more stringent requirements applicable to hazardous waste management facilities.California facilities that handle or process used <br /> are re to Mee se more stringent req ents,and some out-of-state facilities that process used oil also meet those requirements. <br /> 'rhes clude more stringe rt leak detection and rev noon requirements,engineering certifications of tank integrity,and financial assurances For <br /> clo re and accidental rele sea.It is lawful to se ed oil to out-of-state facilities that complyonly with federal used oil management standards <br /> an not these more stri ents. tificatirm is for information purposes on) <br /> S 1.9 1Z i3 <br /> �UIZ <br />