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G <br />As <br />Evergreen Enviftmental Services 10 <br />Contain d Services <br />dedicated to the protection of the envhonmew <br />To schedule a pickup, call Send payment to: <br />800-596-9455 Evergreen Oil Inc <br />6880 Smith Ave., Newark, CA EPA# CAD982413262 P.O. BOX 30517 <br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Los Angeles, CA 90030-0517 <br />GENERATORIJOB LOCATION RII.I.tN(_ TNrhlDMATrn%T <br />N-2 3 140! <br />�a1esOrder,* <br />7 / <br />Date��" <br />NAME j� <br />( ,7 r l r <br />-7 S E ZIP <br />O. <br />., ..�...,.. <br />NAME <br />ADDRESS <br />CITY STATE 4ZtPCO. <br />CASH ❑ CH CK <br />It Ll I <br />COST MER C D <br />PO # <br />0 -NO. <br />PHONE NO. <br />PRO <br />CUSTOMER EPA ID NO. <br />.PRODUCT <br />WASTE MANIFESTQUANTITY <br />CODE NUMBER <br />UNITS PRICE AMOUNT <br />Waste Latex Paint (Non-RCRA) <br />- <br />Waste Latex Paint (Non-RCRA) <br />Waste Paint Related (Flammables oil based) <br />Waste Paint Related (Flammables oil ------ <br />Waste Aerosols Cans <br />Nun-RCRA Hovlydous Wasle. Solid (soil. <br />Dcbris cnmeminamd wilh ooleum Is dvwnrbons) <br />Now-RCRA HavNous Wu4e. Solid (Soil. <br />Debris 000.iwred with' roleuln M1 dnwaftns <br />- <br />Waste Corrosive Liquids, n.os. <br />Waste Flammable Liquids, n.os. <br />r <br />Waste Flammable Liquids, n.o.s. <br />Non-RCRA Hazardous Waste, Liquid <br />Non-RCRA Hazardous Waste, Liquid ,l <br />Waste Toxic Liquids or Solids (Class 9) <br />Waste Oxidizing Liquids or Solids �- <br />Drained Used Oil Fillers <br />Empty Drums <br />Non Hazardous Water <br />Non Hazardous Water <br />Non Hazardous Solids <br />Non Hazardous Solids <br />Glycol Bulk 50/50 <br />Glycol Bulk Cone. <br />TSDF t <br />❑Evergreen Oil, Inc. CFR ❑ <br />6880 Smith Ave. 33210 Western <br />Newark, CA 945 Union City, CA 94587 <br />CAD98088741 CAL00009t507 <br />Source: ❑ C011eCtlOn Station ❑Government <br />❑ Marine ❑ Agricultural ❑ Industrial <br />TOTAL CHARGES <br />✓ <br />Generator certifies that it has established a program to reduce the volume or <br />quantity & toxicity of the hazardous waste Lo the degree determined by <br />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 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 stringent requirements. This notification is for infotmatie purpose <br />r, <br />river Sivnahlre Print Name Route # nntp C:Pnarntnr JCionanlrr Print Name TlarA <br />