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evergreen Envonmental Services. <br /> Containerized Services <br /> dedicated to the protection of the environment / <br /> To schedule a pickup, call Send payment to: <br /> Sales Order # <br /> 800-596-9455 Evergreen Oil, Inc. <br /> f 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: <br /> GENERATOWJOB LOCATION BILLING INFORMATION <br /> ` NAME NAME CASH []CHECK <br /> ADDRESS # <br /> ADDRESS CUSTOMER CODE NO. <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID 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 /> Noo-RCRA HoeaN.1 Wove.solki(soil. <br /> 4hri.pmlarnlow wish luteum h rr iUm. <br /> Nnn-RCRA klmardoul Wasw.St (soil, <br /> nelui,evmmniruleJ Nilh Indeumh Alueybrm[I <br /> Waste Corrosive Liquids,n.os. <br /> Waste Flammable Liquids,n.os. <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 Fillers <br /> Empty Drums <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 C RGES <br /> TSDF <br /> i <br /> ❑ Evergreen Oil,Inc :-J--1 CFR ❑ <br /> 6880 Smith Ave. 33210 Western <br /> Newark,CA 94560 Union City.CA 94587 <br /> CAD980887418 CAL 07 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: ❑Collection Station ❑Government <br /> quantity&toxicity of the hamrdous waste to the degree determined by <br /> ❑Marine ❑ Agricultural ❑ Industrial generdtor 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 />