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F,vergreen Environmental Services No 69871 <br /> Contain(.,rized Services <br /> dedicated to the pre Rection of'the environment <br /> -�/ To schedule a pickup, call Send payment to: Sales Order# <br /> 800-596-9,155 Evergreen Oil.Inc. <br /> 6880 Smith Ave..Newark,CA EPA#CAD98 413262 Dept.LA 23234 <br /> 16.540 S.San Pedro St..Carson,CA EPA#C D982413262 Pasadena,CA 91185-3234 Date: <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> ME 9NAME CASH ❑ CHECK <br /> i # <br /> ADDRESS ADDRESS C 'STONI R CODE NO. <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> P3jOE 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(Flanunables oil based) <br /> Waste Paint Related(Flammoil based) <br /> Waste Aerosols Cans <br /> Num RCRA tlazanlnus Waste,Snlid Soil, <br /> Ucbris contaminated with pomleunt ItydmcarMms) <br /> Nun-RCRA Hantrdmts Waste.Snlid t5oil, <br /> Uebris euntaminut vl with xtroleum h d—arhons) <br /> Waste Corrosive Liquids.n.o.s. <br /> Waste Flammable Liquids,n.o.s. <br /> Waste Flammable Liquids,n.os. <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 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 Conc. <br /> TOTAL CHARGES <br /> TSDF <br /> ❑ Evergreen Oil.inc. SA Recycl ng ' <br /> 6880 Smith Ave. 33210 We.tern C, <br /> Newark,CA 94560 Union City.CA 94587 <br /> CAD980887418 CAL0003 4530 <br /> Generator 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 ❑ Agrie ltural ❑ 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 /> IMPORT ANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br /> Per California Health and Safety Cod Section 25250.9,Evergreen hereby advises customer that customer's shipment of used oil may be <br /> transported to a facility that is required t comply with federal regulations applicable to management of used oil,but that is not required to <br /> comply with the more stringent requiren ients applicable to hazardous waste management facilities.California facilities that handle or process used <br /> oil are required to meet those more strip zent requirements,and some out-of-state facilities that process used oil also meet those requirements. <br /> These include more stringent leak deteci ion and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> closure and accidental releases.It is law ul 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 />