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Evergreenk*,r lmental Services Qrized Services N-- 3 3 3 <br /> cleelk'tdtcrl <br /> It,the prrrtectiou of the ell ironmenr To schedule a pickup, call Send payment to: U <br /> 800-596-9455 Sales Evergreen Oil, Inc. <br /> 6880 Smith Ave., Newark,CA FPA#CAD982413262 P.O- BOX 30517 <br /> 16540 S. San Pedro St.,Carson, CA EPA#CAD982413262 Los Angeles, CA 90030-0517 <br /> GENERATOR/JOB LOCATJON pa <br /> NAME BILLING Da <br /> ADDRE%.� NAME CASH [J CHECK[] <br /> SS ADDRESS # <br /> L� E IP 'CO. CITYSTATE # L/ <br /> ZIP CO. PO # <br /> ONE NO. PRONE NO. PROFILE NO. <br /> 4 1 ( 1 U TOMER <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Waste Latex Paint(Non-RCRA[ <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Paint Related tFlamma6les oil based) <br /> Waste Paint Related (Flammables oil based) <br /> Waste Aerosols Cans <br /> Kun-RCRA H..rdnw w w. Suhd <br /> nrhm nn:i-'-MM with 1+ieom h d,—,ho - <br /> N--RCRA Har_done W <br /> Waste corrosive Liquids, n.os. <br /> Waste Flammable Liquids, n.o.s. <br /> Waste Flammable Liquids, n.o,.s. <br /> Nan-RCRA Hazardous Waste, Liquid <br /> Nan-RCRA Hazardous Waste, Liquid <br /> Waste Toxic Liquids or Solids(Class 9) <br /> Waste Oxidizing Liquids or Solids <br /> Drained Used Oil Filtgs <br /> Empty Drums <br /> Non Hazardous Wate <br /> Non Hazardous Water <br /> Non Hazardous Solids <br /> Non Hazardous Solids <br /> Glycol Bulk 50150 <br /> Glycol Bulk Conc. <br /> c/ <br /> TSDF TOTAL CHARGES <br /> Evergreen Oil, Inc. CFR <br /> 6880 Smith Aue. �33210 Western �_ I <br /> Newark,CA 94560 Union City,CA 94587 <br /> CAD980887418 CALM91507 <br /> Source: C❑ Collection Station ❑Government Generator certifies that it has established a program to reduce the volume or <br /> quantity&toxicity of the hazardous waste 1n the degree determined by <br /> ❑ Marine ❑ Agricultural 0 Industrial generator to be economically <br /> practicable. <br /> I hereby certify that I have read and have the authorit to <br /> Retain sample # bind the above listed enerator to the terms on the reverse <br /> side of this Form. <br /> IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br /> Per Calirornia 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 preventic,n requirement;, engineering eertificatinns of tank integrity, and financial assurances for <br /> closure and accidental releases. It iS lawful to send used oil lu out-of-state facilities that comply only with federal used oil management standards <br /> and not these mor stringent requirenlents. This notif'ication *)r inli?emotion purposes only. <br /> �ti ` <br /> i <br /> C r t !" <br />