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— Containerized Services <br /> drdicurr•r1 fu the pnw<, of the e•tvrmrtnre•rd <br /> To schedule a pickujrltll Send payment to: Sales Order# <br /> 800-596-9455 Evergreen Oil. Inc. <br /> 6380 S1nah A%c-Ncwttrk,CA hl-A#CAIY)h-1d 13262 Dept. LA 23234 <br /> 165.#(1 S.San Pedro St-Camm.CA EPA#VAM82a 1326' Pasadena,CA 91185-3234 Date: <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> N:I�E �/ <br /> NAME. CASHE] CHECK <br /> :1DDRESSADDRESS CUSTOMER CODE NO. <br /> CIT ' STA'TE ZIP CO. CITY STATE. ZIP CO. PO# <br /> - iz <br /> PUONf NO PHONE NO. PROFILE NO. CUSTO IER EPA 11)NO. <br /> 7 - 5��� ( 1 r I �.T <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE: NUMBER <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Latex Paint(Non-RCRA) S <br /> Waste Paint Related(1-lammables oil based) <br /> Waste Paint Related(hlarnmab)cs oil based) <br /> Waste Aerosols Cans _ <br /> UctnirnnlanttnWcd xiah kum h dn::utru. <br /> �mpt'NA ItumLtin Wa+ur.SHAW 1&til. <br /> I1clnia xioWnimtW with magma Jrvearhmaa <br /> Waste Corr'sive Liquids.n.o.s. <br /> Waste Flammable Liquids.n.o.s. - <br /> Waste Flammable Liquids,n.o.s. <br /> Nun-RCRA Hazardous Waste,Liquid 712-1 <br /> Non-RCRA tlazaadous Waste.Liquid <br /> Waste*mirSolids(Class 9) +�- <br /> Waste Oxiduing Liquids or Solids <br /> Drained U.ed Oil Fillers <br /> Empty Drurm f i - S /l►1 <br /> Non Hazurdou�«arca <br /> Non Hazardous Water- -- —— -- <br /> Non Ha2ardoas Solids <br /> Non Hazardous Solid. <br /> Glvcol Bulk 5(/50 <br /> Glycot Bulk Cunc. — <br /> �� f <br /> TOTAL CHARGEES <br /> TSDF <br /> V Evergreen Ur), SA Rc'ycling ❑ ���� <br /> t�1 6880 Smith Ave. 332I1)Western <br /> Newark_CA 94560 Union City.CA 94587 <br /> CAD980887418 CALLW344530 <br /> Generator certifies that it has established a program to reduce tlx:volunu or <br /> Source: ❑Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree detcrnined by <br /> ❑ Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify that i have read and have fhe authority� <br /> Kind the above listed generator to the terms on the revgrse <br /> Retain sample# side 0f this form. <br /> IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br /> Per Califorttia Health and Safety Code Section 25250.9,Evergreen hereby advises c•usto rner that customer's shipment of used oil may he <br /> transported to a facility that is required to comply %vith 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 taut-of-state facilities that process used rail 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 tioL;ideuiLaLzalvases. it is lawful losend used oil to out-of-%lute facilities that comply only wi t federal used oil management Standards <br /> and not t . more stringen equire ts.This notification is for information purroscs only01 . <br /> Driver Sianore Print Name Route # —[Ta t-e Gene trar _nature Print Name Date <br />