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Evergreen EnviAM*ental Services o _ y <br /> Containerized Services <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: Order # <br /> 800-596-9455 Evergreen Oil, Inc. <br /> 6880 Smith Ave., Newark,CA EPA#CA0982413262 P.O. BOX 30517 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles, CA 90030-0517 Date: -� �V/ <br /> GENERATOR/JOB LOCATION BILLING INF TION <br /> NANIE CASH Q CHECK❑ <br /> ADD S �� /✓/�//f ADDRESS # <br /> SiODF,�O <br /> STA CO. CITY 7STATEZIP CO. PO#PHONE NO. FILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTTTY UNITS PR[CE AMOUNT <br /> CODE NUMBER <br /> Waste Latex Paint(Non-RCRA) ' <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Paint Related(Flammables oil based) <br /> Waste Paint Related(Flatnmables oil based) <br /> Waste Aerosols Cans ' <br /> Noe-acan aem 'ween.soba(soa, <br /> Debris comomimcetl with nmlam hvdrxartoes <br /> Non-aCRA Hvmdous Waste,SoliG(Soil, <br /> Debtix rnnmmineted with lutm M1VNaothons ' <br /> Waste Corrosive Liquids,n.o.s. <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 <br /> Empty Drums <br /> Non Hazardous ater IF <br /> Non Hazardous Water <br /> Non Hazardous Solids <br /> Non Hazardous Solids <br /> Glycol Bulk 50150 <br /> Glycol Bulk Conc. <br /> TOTAL CHARGES <br /> TSDF <br /> ❑ Evergreen Oil,Inc. m CFR <br /> 6880 Smith Ave. 33210 Western ❑ <br /> Newark,CA 94560 Union Ciry,CA 94587 <br /> CAD980887418 CAL00009I507 <br /> Source: ❑ Collection Station ❑ GOverrur ent Generator certifies that it has established a program to reduce the volume or <br /> quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> bind the above listed generator to the terms on the reverse <br /> Retain Sample # side of this form. <br /> IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br /> Per California Health and Safety Code Section 252509,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 prevention requirements, engineering certifications of tank integrity, and financial assurances for <br /> closure and accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil managementstandards <br /> and not these more stringent requirements. This notification is"for information purposes only. <br /> d •�.�1/— / " �G�'��/ J, IAt f/pc's>;t I�Y� 2 <br />