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./ <br />Evergreen Enviramental Services <br />CopServices <br />thero dedicated to the protection of the environment <br />To schedule a pickup, call Send payment to: <br />800-596-9455 Evergreen Oil, Inc. <br />6880 Smith Ave., Newark, CA EP" CAD982413262 P.O. BOX 30217 <br />16540 S. San Pedm St.. Carson, CA EPA# CAD982413262 Los Angeles, CA 90030-0517 <br />Sal4fdrae ?-�/ <br />Date/� 24r7- O F <br />PRODUCT WASTE MANIFEST <br />CODE NUMBER <br />QUANTITY UNITS PRICE AMOUNT <br />Waste Latex Paint (Non-RCRA) <br />Waste Latex Paint (Non-RCRA) <br />Waste Paint Related (Flammables oil based) <br />Waste Paint Related (Flammables oil based) <br />Waste Aerosols Cans <br />Nao-RCaA Hez Npu Wage. Sdq (Soa. <br />Debris rnnlamiaval wiN learn M1 tlsnce,M1ons <br />NomR,RA Ilaia�dous Wrist $did (Shc, <br />Obis mnuminaetl xti0 Irduw b <br />Waste Corrosive Liquids, mo s. <br />Waste Flammable Liquids, n.o.s. <br />Waste Flammable Liquids, mo.s. <br />Non-RCRA Hazardous Waste, Liquid <br />Non-RCRA Hazardous Waste, Liquid <br />Waste Toxic Liquids or Solids (Class <br />Waste Oxidizing Liquids or Soli <br />Drained Used Oil Filters <br />Empty Drams <br />Non HazardousWater <br />Non Hazardous;mer <br />Non Hazardous Solkli <br />Non Hazardous Soli <br />Glycol Bulk 50/50 <br />Glycol Bulk on, <br />TSDF <br />❑Evergreen Oil, Ittc. CFR ❑� <br />6880 Smith Ave. 33210 Western <br />Newark, CA 945 Union City, CA 94587 <br />CAD980887418 CALD00091507 <br />Source ❑Collection Station ❑ Government <br />0 Marine ❑Agricultural ❑Industrial <br />TOTAL CHARGES <br />certifies that it has established a program to reduce the volume or <br />quantity <br />quantity & toxicity of the hazardous waste to the degree determined by <br />generator to be economically practicable. <br />T re -e. -h. ..-rfie- On.. r s.--- ..--a --A r. -..e .r.......�,.:.-. . <br />Retain sample # <br />bind the above listed generator to the terms on the reverse <br />side of this form. <br />B4PORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br />Per California Health and Safety Code Section 25250.9, 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 management standards <br />and not these more stri ent requirem nts. This nofification is r info fion purposes only. ( ,, /, <br />�� Mrd" , <br />Generator's Signature Print Name Date <br />