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55758 <br /> j Evergreen Environmental Services - <br /> Containerized Services <br /> dedicated to the protection of the environment el <br /> To schedule a pickup,call Send payment to: A% <br /> Sales O <br /> 800-596-9455 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 �! <br /> 16540 S.San Pedre St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date; <br /> G ' TOR/JOB LOCATION BILLING INFORMATION <br /> NAME CASH CHECK <br /> Q <br /> 0. [TY A O. <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(Flamtnables oil based) <br /> Waste Aerosols Cans <br /> Debris coutandmodvia, km, <br /> m. <br /> Debns tome�rona�ruh mkum h <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 Ott Filters <br /> Empty Drams <br /> Non Hazardous Water <br /> Non Hazardous Water <br /> Non Hazardous Solids <br /> Non H Solids <br /> Glycol Bulk 50150 <br /> Glycol Bulk Conc. <br /> TOTAL CHARGES <br /> TSDF <br /> Evergreen Oil,Ave. CFR t/✓d tL,�Y <br /> 6880 Smith . CFR Western <br /> Newark,CA 94560 Union City,CA 94587 <br /> CAD980887418 CAL0MI507 <br /> Source: ❑Collection Station ®Gvvemment Generator certifies that it has established a program to roduce the volume <br /> quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑ Marine U Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby cera y that I have read and have the authorit o <br /> Retain sample# hi u � � ted aettePA—tor to the firms on rhe reverse <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 riot these more stringent requirements.This notification is for information purposes only. <br /> Driver Signature Print Name Route# Date neratoPs Signature Print Name Date <br />