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i Evergreen EnviAmental Services N° 321. 54 <br /> Containerized Services <br /> ededicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: Sales Order# <br /> 800-596-9455 Evergreen Oil,Inc. �q <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 Date: tJ <br /> GENE TOR/JOB LOCATION BILLING INFORMATION <br /> EME CASH❑ CHECK❑ <br /> RES ADDRESS <br /> ZIP CO. CITY STATE ZIP CO. PO# <br /> HONE PHONE NO. PROFILE NO. CUSTOMER EPA ED NO. <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 /> Nm-RCRA Harndous Wane.Solid(Soil. <br /> oe conumimml whh ,oleua h deo ..) <br /> Nm-RCRA H...d W.,Mid(Soil. <br /> neb,is .muted wM eum h d,oraAms <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 Filters <br /> Empty Dnrms <br /> Non Hazardous <br /> Non Hazardous Water <br /> Non Hazardous Solids <br /> Non Hazardous Solids <br /> Glycol Bulk 50/50 <br /> Glycol Bulk Conc, <br /> TOTAL CHARGES <br /> TSDF j <br /> ❑ Evergreen Oil,Inc. CFR <br /> Ne% Smith Ave 3 ion Western <br /> Newark,CA 9 60 Union City,CA 94587 <br /> CAD996887418 CAL000091507 <br /> Genemlor 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 Ll 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 /> trasported to a facility that is required to comply with federal regulations applicable[o management of used oil,but that is not required to <br /> n <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 facties 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 <br /> and 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 /> not[hese more stringent requirements.This notification is for information purposes only. <br />