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Evergreen Environmental Services NO 32401 <br /> Containerized Services <br /> 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 EPA#CAD982413262 P.O. BOX 30517 <br /> 16640 S.San Pedro St.,Carson,CA EPA#CAD98 3262 Los Angeles,CA 90030-0517 Da 1 i <br /> RATOR/ OB LOCATION BILLING INFORMATION <br /> �� /r ME CASH Q CHECK <br /> # <br /> A 'y ADDRESS p <br /> CITI'�(/ TA CO. CITY STATE ZIP CO. PO# <br /> PHONE NO. PHONE NO. PROFH,E NO. C S <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE 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(Flammables oil based) <br /> Waste Aerosols Cans _ <br /> N-Re HvaNaus .,,Wine.Solid(Sail, <br /> .g.,is conmmine¢e wish .team h sl <br /> N.RCRA ii v .s\Vauv.Solid(Soih <br /> omN:[aalmniaaLLd.;.h vamam h amca,hws <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 File <br /> Empty Drams s <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 /> TOTAL CHARGES <br /> TSDF <br /> fC-I Evergreen Oil,inu/��CFR <br /> '---��J 6880 Smith Avec �1-1'33210 Western O f <br /> Newark,CA 560 Union City,CA 94587 <br /> CAD980881418 CALOM1507 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: ❑Collection Station ❑Government 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 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 information purposes only. - <br />