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0 <br />Evergreen> ronmental Services <br />wl"OpIn'tecrion <br />nerized Services <br />dedicated oJ'ihe envirUnment <br />To schedule a pickup, call Send payment to: <br />800-596-9455 Evergreen Oil. Inc. <br />GRan Smith Ave.. Newark, CA EPA# CAD982413261 Dept. LA 23234 <br />16540 S. San Pedro SL. Carson, C:A 6PAx CAU9R2413262 Pasadena, CA 91185-3234 <br />GENERATOR/JOB LOCATION BILLING INVORMA'PION <br />-- <br />Na 55601 <br />Sales Order # <br />Date: <br />-Awrcreams <br />(2.J <br />NAME <br />Is <br />CASH CHECK E] <br />G <br />ADDRESS <br />CUSTOMER COKING. <br />s <br />CIT ST I <br />CO. <br />CITY <br />19 <br />STATE ZIP CO. PDX <br />P ONE AO. Qp <br />PHONE NO. <br />PROFILE NO, CUSTOMER '0. <br />PRODUCT <br />Waste Latex Paim_(Non-RCRA) <br />Waste Latex Paint (Non-RCRA) <br />Waste Paint Related (Flanunables oil based) <br />Waste Paint Related (Flarnmables oil based) <br />Waste Aerosols Calls <br />Nb„- kA .va,duu. Waage, li fxoil. <br />neMvm uminaiad wish Imkr h earhwla <br />Na,.0.0 A Nara ane, aid (Soil, <br />Debria fonla -Halal will au I r m h , awrl oral <br />Waste Corrosive Liquids, -- <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 <br />Empty Drums <br />Non Nazurdous Water <br />Non Hazardous Water <br />Non Hazardous Solids <br />Non Hazardous Solids <br />Glycol Hulk SO/50 <br />Glycol Bulk Color, <br />WASTE <br />CODE I kNUMBERr I QUANTITY UNITS <br />Oil,( CFR ❑ <br />h Ave.. fM1� 33210 Western <br />A 94540 Union Citv. CA 94587 <br />PRICE I AMOUNT <br />3 r0 <br />Source: ❑ Collection Station ❑ Govenunent Generator certifies that it hes established a program to reduce the volume or <br />quantity & toxicity of the hazardous mucic to kiln dcglne detiaimmod by <br />Q Marine 0 Agricultural Q Industrial generatormbecemlomtcally piacticabie. <br />I herehv aertifv that I have r^ad Bad have thebythnt:ih to <br />Retaill somple # bind the above listed gererctor to the terms or the povilrAc <br />tilde 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 custamer's shipment of used oil may tae <br />transported to a facility that is required to comply with federal regulations applicable to management of used oil, but that is not lequiled to <br />comply Wldt lh@ n1ePe S{I'l I1gE111 tegalrertl@nlc applicable In 11azm'dnuc W'pxl@ management facilities. California facilities that handle or process used <br />dig are required to meet those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirenteats. <br />lose include more stringent leak detection and prevention requirements. engineering certifications of lank integrity, and financial assurances for <br />losure and accidental releases. It is lawful to send used oil to out -of -titre facilities that comply only with federal used oil management standards <br />and not these more stringent requirements is notification is for information purposes only. <br />