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12 n <br /> • ServicesManifest Submissdon to _ 9' <br /> "nen' <br /> t end payment to: Sales Order# <br /> Generator sends <br /> t , ,'nifeshipmenttbl Evergreen Oil,Inc. <br /> r P.O. BOX 30517 . O <br /> Department ngeles,CA 90030-0517 Dale: ty <br /> 4110 <br /> t ' " ING INFORMATION, <br /> www.evergreen' tCASHE]CHECKE]E . <br /> DR�CIT T IP CO. CITY STATE ZIP CO.PHONE N PHONE NO. PROFILE NO. <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(Flan mablm oil based) <br /> Waste Aerosols Cans <br /> N.-RCRA H.mN Wes¢.SdiE\soil. <br /> oewis conieminand wiiM1 imkum d <br /> NonRCRA IlvvMue Wme,Sd'M(Sail, <br /> oekls mmammead wnM1 mkum n a�a•:,�m„: <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 .1 <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 /> TS E.F <br /> 688vf 0 Smith men Avec ❑ 32110 Western ❑ ��® <br /> Newark,CA 94560 Union City,CA 94587 <br /> CAD980897418 CAL11M1507 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Cl 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 /> RC1H 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 mo stringent ements. This notification is for information purposes only. <br /> �� a� <br />