Laserfiche WebLink
Evergreen Env ►amental Services No 6 Q <br /> Contai—rized Services <br /> dedicated to rite protection of the environment <br /> To schedu e a pickup, call Send payment to: <br /> Sales Order# <br /> 800-596-9455 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: / <br /> GENERATOR/,JOB LOCATION BILLING INFORMATION <br /> N�E NAME CASH❑CHECK❑ <br /> # <br /> AU RESS ADDRESS CUSTOMER CODE NO. <br /> ZTe <i✓ ' G� Gl <br /> CIT STAT I ZIP CO. CITY STATE ZIP CO. PO# <br /> z4e a, G_ <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) G <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Paint Related(Flammables o 1 based) <br /> Waste Paint Related(Flammables o 1 based) <br /> Waste Aerosols Cans <br /> Non-RCRA liawrdous Waste.Solid(Soil. <br /> Debris contaminated o,ith petroleum h drocerboas) <br /> Nan-RCRA Hazardous Waste.Solid(Soil. <br /> Debris contaminated with etn)Ieum hvdrucarbonsl <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,Liqu d <br /> Non-R A Hazardous "ste.4iqu d <br /> Waste oxlc ,al (Cla•s 9) <br /> Waste Oxidizing Liquids or Solids <br /> Drained Used Oil Filters <br /> Empty Drums �. <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 /> C> .• - �"? I' A lig <br /> TOTAL CHARGES <br /> TSDF <br /> Evergreen Oil.Inc. SA ecycling <br /> 6880 Smith Ave. 332 10 Western ❑ t ((/CG'-1��419 <br /> Newark,CA 94560 Uni n City,CA 94587 <br /> CAD980887418 CA 000344530 <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 ❑ Agnicultural ❑ 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 /> IMP RTANT 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 i5 lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> and not these mate ent requirements.This notification is for information purposes only. <br /> Driver Signa re -Ti' ame Route# Date Gen ntnr'-, "Zienitura Print Noma r,,.. <br />