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J <br /> A/ <br /> Evergreen Environmental Services NO 3217E;, <br /> Containerized Services '1 <br /> / dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: Sales Order # <br /> 800-596-9455 Evergreen Oil, Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 P.O. BOX 30517 O <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles, CA 90030-0517 Date: <br /> GENERATOR/JOB LOCATION I BILLING INFORMATION' <br /> N E CASH Q CHECK <br /> /�45 / # <br /> D ADDRESS COODE <br /> CIT JIP CO. CITY STATE ZD' CO. <br /> T PO# <br /> PRONE N PHONE NO. PROFILE NO. CU OMER EP <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER 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 /> =RC Hemidous WmR.Solid(Soil. <br /> Deb., = ,= = <br /> s mnm ,nolN wish kora h <br /> Nam RCRA Hvdau�Wane.SoIW(Soil. <br /> Debris wnmmim��d wish kum h dmcmbws) <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 ers �� <br /> Empty Drums .S <br /> Non Hazardous Water <br /> Non Hazardous Water <br /> Non Hazardous Solids <br /> Non Hazardous Solids <br /> Glycol Bulk 50150 <br /> Glycol Bulk Conc. <br /> TOTAL CHARGES <br /> TSF p/ <br /> T Q—��1(Evergreen Oil,Inc. CFR J6.0 <br /> 6880 Smith Ave. 33210 Western <br /> Newark,CA 94560 Union City,CA 94587 <br /> CAD980887418 CAL000091507 <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. Itt is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> and not [hese mo stringenements. This notification i�r information purposes only. <br /> at <br /> t <br />