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AUT,i-1Z-Zoos IZ:14PM FROM-EV'ER0EEN 510-i9i-01 0 T-510 P"004/005 F-15T <br /> vergreein Eavil,"4-.�irnentai �er��ces 0 419 5�9 <br /> Mdedicatcd to the protecricn nf+hc urMrOnMent <br /> ~- Ta'schedule a pickup, call.. Send payment t0: Sales Order 41 7 f?Ca <br /> 800-596-9 .55 Evcrgmen Oil;Inc. <br /> BOX 30517 <br /> 0. <br /> 68aa Smith Ave.,Newark,CA EPAIt CAl]9824132Li2 F- _ — <br /> 165406, San Pedro St.,ctarson,OA "EPAV CAD982413262 Los Angeles, CP,90030-0517 Date: — <br /> GENERATOR/jOB LOCATION flILLING E-ifOIt_MATION CASH CHECK❑ <br /> NAl'VI� . <br /> NAlvf S'; t cOs rdrtrElr CODE NO. <br /> ADDRESS ADDRESS <br /> CITY STATE ZIP Co. CITY <br /> STATE 'LTI' co. TO� <br /> 5i 9w ] <br /> ONTE NO. r PHONE NO. PROFILIC NO• CUST�IMgR EPA lb NO. <br /> 1 L <br /> Ch � <br /> WASTE mANIFF,ST QUANTITY UNITS PRICU AMOUNT <br /> PRODUCT CODE PP(I1►xIIER <br /> tlsed oil.Non-RCFA tlazardous Lubricating CA-221 <br /> Waste,Liquid Industrial CIA221. <br /> -5-"d A7lammk CA13sl Gal, <br /> Maie U wd CA221 <br /> lik'1'✓a}lo ComUunilbh Llqula,N.0.5,NA FU7lrFnn2 Gal, - <br /> a793 an Or rn +�=d wi[h halo ens <br /> Oil 8t Water„Non-RCPA Hazardous Waste LiC111d CA fc (? GAT. <br /> Waste Solids and Sludges Gal. <br /> Each <br /> Wash Out <br /> Drum <br /> Drained llscd Oil Filters <br /> Non-RCRA Razardaus Waste Solids(oily cicbrisl CA223 Drum <br /> Drum <br /> Ernply Drisms <br /> '1runspor[Mion L lits, <br /> 1„ CTA1” <br /> Nan'Hazardou%Water <br /> C1ycol Bulk 50150 Gal, <br /> r Gal. <br /> Glycol Bulk Conc. <br /> 0 <br /> F TEST'❑Clot D Tech 4900--JPPm ❑Clor D Tech 100901'ass❑Fail © Halogen DeteclorlFlatnc Test El Pass ❑Fail <br /> Tot Char >rs <br /> Ficld Service Work T3cscription_ <br /> v <br /> Other. <br /> Dater <br /> Vacuum Services Tire <br /> out of Ynlrl fin Site Off Site Off Load Start Off I-oad find _Return to Yard tom„/ ,1G' <br /> TSDF ❑ Cop0lidated Mftnifest <br /> Cvergreen Oil,Tor. Cvcrgrecn Env.Svc, n fiyctgrrcn Env.Svc, ❑.AJS-Fiircr ❑— <br /> 6880 Sinidi Ave, Road 308 I--r n139 N_Valentina 15131 ClnFk Ave. <br /> Newark.,CA 94560 Davis,CA 45616 Fresno,CA 937da00 <br /> 22 ICndas[ryp 07432745" <br /> CAD980987418 CAD99244GB74 CAD98240M2 " <br /> Evergreen Bnv.Svc. ❑CFR ❑ CFR ❑ 3474GromnTaf Env-Svc. <br /> ❑ 16604 east Env,SvcGro ❑ i3 <br /> 1660=t S.Sun Petlro 745 a West IIctlerrvia 944 P.Slaitsun Ave. 33210 Wes[et'n 3474 Toyon Circ[c <br /> Carson,CA W146 Santa Marin,CA'93454 Los Angeles,CA 90011 Union Cityy•CA 94587 Vglley 5ppnngs,CA 95352 <br /> CAD981696420 CAd982446858 CAL0001:17.021 CAWO0091507 CAL00021441-1 <br /> Generator cnnilics that it has cs[nblished Q program tet reduce the volume or <br /> Source; ❑Collection Station J Government quantity&toxicity of the hazardous wasto to dtc degme daiermincd by <br /> :1 Marine ❑ Agricultural C# Industrial generator to be economically practicable, <br /> I herebycertify that I have read and have the authority to <br /> hired the above listed eneratar lt) the terms oo the reverse <br /> Retain sample # side of this Porta. <br /> IMPORTANT NOTICE RE,CARDING THE DISPOSI'T'ION OF YOUR OIL, <br /> per California Health :end Safety Code Section 25250.9, Evergreen hereby advi3as custorner that customer's shipment of uscd oil way be <br /> transporTed to a facility that is required to comply with fcdC:ral reguladons applicable to management of uscd oil,but that is not required to <br /> comply wiry the more stringent requirements applicable to hazardous waste managentertt facilities.California facilities that handle or process uscd <br /> oil are required to meet those mflre strin�ent requirements, and some out-of-state.facilirics that process uscd oil also meet those reCluieernents. <br /> 'filen. 11]4:1LIti1r," morn sLnnganr Kelt deteet,nn artid provetnaan requirements;- vn2.u1eerinp L-tt coiiply a y [tiTh integrity, and MfInialicial ascTit S MI for <br /> closure, ar'd LnCidun[al releases, 1t is lawful to send used oil to out-of-state facilities that coniply �tdy with federal used ata m lnagemcnt s[antlarQS <br /> and not these mot requirements.'Viiis"natification is for information purposes only. <br /> � [ /" �• <br />