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05/23/2011 HON 15: 57 FAX 209 667 1124 Blackmun Equipment 2016/029 <br /> ,AK, Evergreen Environmental Services <br /> Containerized Services <br /> / dedinued m rhe pmrocrion ujnce rnvimnmesr <br /> To schedule a pickup,call Send payment tot <br /> Sales Order# ', f�-�' _;.3g- <br /> 800-596-9455 13vergrccn Oil.Inc. <br /> 68X0 Smith Ave.,Newark,CA 1 PA#CAD982+113262 Dept.LA 23234 <br /> 16540 S.San Ndm Nt•,Qmrs CA ern#CA09824132l,' Pasadena,CA 91185-3234 Date: 15 < <br /> GF,NFLRATOR/JOB LOCATION BILLING INFORMATION <br /> NAME <br /> CASH n ,HECK <br /> # <br /> AAARESSeADDRESS CUSTOMER CODE NO. <br /> L s S t <br /> crrY srArE 7m " ITY co. CsTnrE ZIP co: PU# <br /> Jt _ �3?lve <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA rD NO. <br /> PRODUCT WASTE MANIFEST CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Write Latex Nint(Non-RCRA) <br /> Waste Latex Puinl(Nun-RCRA) - <br /> WaaLe Paint Related(Flammablm oil based) <br /> Wade paint Relaid(Flammdblex nil hsscd) <br /> Write Aerosols Cana <br /> Nan NcxA nuuauu NVnu;SNN S.& -' <br /> rkEris aon4aninssedwth krona xm.,tam <br /> mansNn MA w.nNwawane,aeYE(sen. <br /> [muminuN M4 an,4irm <br /> wastC Corrosive LiquiLk n^s. <br /> Wasie Flanwtable Liquide,n.o.s. <br /> waste rlummahle Liquids.a.o.s. <br /> Non-RCRA Hazardous Waste,Liquid <br /> Noa-RCRA Ilararanus waste,Liquid <br /> Waste Toxic Liquids or Solids(Class 0) . <br /> Write Oxidizing Liquids or Solids <br /> Drained Used Oil riper <br /> Empty Dmms ?f/ 40 <br /> Non Hazardous Water- <br /> Non <br /> aterNon Hazardous Water <br /> Nun Hazardous Solids <br /> Non Hamnloas Solids <br /> Glycol Bulk 50150 <br /> Glycol Hulk Cmc. <br /> TOTAL CIiARCES <br /> TSDF <br /> ❑ Rvergrccn Oil,Inc. SA Reeycling ��OQ <br /> 6880 Smith Ave. 33210 Uyeatern <br /> Newark,CA 94560 Uaim City,CA 94587 <br /> CAD980887418 CAIAXK344530 <br /> I Generela certifies that it Inas established a program to reduce the volume or <br /> Source: C3 Collection Station Q(rOVCrlEneltt quantity&-toxicity of the hazardous waste to the degra detc*nt ned by <br /> 0 Marine ❑ Agricultural ❑Industrial generator to be ecunumicatly practicable. <br /> I hereby certify that I have read and have the pgthoritir to <br /> i <br /> Retain sample# bind the above listed yenerawr to the terms an the rev erse <br /> p alae or thiN rnjln. <br /> IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br /> Per California Health and Safety Coda Section 25250.9,rveWcm hereby advises customer that customer's shipment of used oil may be <br /> transported to a facility that is mqutmd to comply with federal regulations applicable to management of used oil,but that is not required to <br /> comply with the niorc stringent requiremeuls applicable m haziutous waste management.facilities.California facilities that handle or process used <br /> ail arc nNuircd to meet those mom stringent requirements,and some out0f--state facilities that process used oil also meel(hose requirements. <br /> These include more;stringent leak demutiun and prevention raluircmcnts,engineering certifications of tank integrity,and financial assurimccs for <br /> closure and wscs.It is lawful to send used oil to out-of-stale facilities that comply only with federal used oil management standards ' <br /> and t 'c more shin :requirements.This notification is for information purposes only. <br /> Driver Signature Print Name Route# Date f Genera Ors t [ e Print ams Date <br />