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Sep 04 09 03: 17p Lindsay Schwager 2099523389 p. 5 <br /> / Evergreen Environmental Services <br /> ped 32?.08 <br /> Containerized Services _ s� <br /> rlediralyd to the prnlectinn of Nta ennirrntrnenr <br /> To schedule a pickup, call Send payment to: Sates O <br /> 800-596-9455 rp en OilInc- <br /> .C. <br /> 30517 <br /> 688D Smith Ave.. Newark,CA EPA#CAD982413262Date: <br /> 16540 S.Sen Pedro St.,Carson,CA EPA#CA0982413262 Los Angeles.CA 90030-0517 <br /> GENERATOR/JOB LOCATION BILLING INFOR TION <br /> ,4l,, CASHE]CHECK <br /> pt <br /> NA ' # <br /> ADDR n � <br /> ADDRESS <br /> Crl' !/ Al ST T 'O. CITY STATE 7,IP CO. PO <br /> r! PHONE NO. PROFILE NO. p <br /> (HONE. <br /> WASTE MANIFEST QUANTITY UMTS PRICE AMOUNT <br /> PRODUCT CODE NUMBER <br /> Waste Latex Paint (r4oh-RCRA) - <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Paint Related(Fl:unmuhles oil bawd) <br /> Waste Paint Related(Flammahlcs nil hascd) <br /> Waste Aemads Cans <br /> Vnmal'aA I:v1,Mwn Was=,S,.I t I5n41. <br /> Ihh',, nax'•I wilx alrvkwn h-n'mMm+: <br /> Xbm�nlalniuA wwi,Waae.&witl ln.uL <br /> Waste Corrosive Liquids.n.o.s.' ` <br /> Waste Fianuaahk Liquids, n.os. <br /> Waste Flammable Liquids,n-u., <br /> Nnn-RCRA Hxm*sas Waste.Liquid <br /> Non-RCRA Hwnrdous Wsste.liquid '- <br /> Write Toxic Liquids or Solids(Class 9) <br /> Waste Oxidizing Liquids or Solids <br /> Drained Uwd Oil Filters <br /> Lmpty Drums <br /> Nom Hazardous Water <br /> Non Hazardous Water <br /> Non Hazardous Solids <br /> Non Hazardous Solids <br /> Glvcol Rulk S1V50 <br /> Glycol Bulk Cmc. <br /> TOTAL CHARGES <br /> TSDF -3-7Q <br /> X7±1 <br /> EvergreenOF-1 ClFR <br /> O Smith oil, <br /> 332 <br /> 10 Western <br /> Newark.CA 945M Union City,GA 94587 <br /> CAIYiBD$8741fl CAU%ID(M715117 Gencratur certifies that it has established a ptogmm to n`ducu the volume nr <br /> Source: ❑Collection Station ❑Government <br /> quantity <br /> eo r nn&o' c�y�M ho`1hmlly vNotoL hk- to(he d goo determined by <br /> ia <br /> ❑Marine ❑ Agricultural ❑ Industrial t hereby cern that I have read and have the authority u. <br /> hind the above listed aenerator to [he terms on the reverse <br /> Retain sample # side of this form. <br /> IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br /> �vcrPer California Health lmd Safety Goode Section 5250.doral regi lel hereby <br /> nPPlilcubk tvises o managemstomer ent of used oil but that ment of notlrequwal toil may o <br /> trauslion d to a facility I <br /> comply with the lion=stringent requirements <br /> roc llicul'10 Lc m1r1 wme wwaste <br /> t�ll.rle facilitiesathaltttpnw ss tLISMltoil also cililicmclG tthoselrcquirc'rmcnts.cess usct <br /> oil are required to nxet!hose mora shin_ I integrity. <br /> These inchide more stringent Irak detection and prevention requimnxnts, engineering ccnil ic:nions of tank into grit and financial assurance." for <br /> chnure untl accidental releases. It is lawful to send used oil to out-of-state facilities that comply only will, federal used oil mallalenlell ua'alanis <br /> and not [hese more stringent trquiremenls. This notilie:uion is for inf�niun (wrpuscs only. <br /> r <br /> __�6�-09 <br /> Driver Signa re Print Name Route # Datc Generator s Signal c Pr ung Dale <br />