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2011-Feb-11 02 10 PM DSW AG 209-3'9-8867 11/42 <br /> v , w <br /> Evergreen Environmental Services N2 29053 <br /> Containerised Services n <br /> .1 dedlratt, to the protection of the envirnnmcnt / <br /> d <br /> To achadyle a pickup, call Send payment to: <br /> 800-596-9455 Evurgreon Oil, Inc, Sales O r <br /> 6880 9niW.4v�'.;Newark,CA SPA#CA0982413282 R0. BOX 30517 �-� <br /> t664d S.San PBnro 8t.,Carson,CA EPA#CADS82413282 Los Angeles, CA 90030-0517 Dat <br /> GENERATOR/ 013 LOCATION BILLING ORIMATION <br /> 1 / NAME... �9 /� � CASH CHECKDDRESS [� <br /> ✓� ADDRESS <br /> CITE, / MTE ZIP - CO. CITY cSJATE IZ � �, of <br /> PHONE Nq. PHONLr N0. PROFILE NO, CUSTOhIER 9PA ID N0. <br /> PRODUCT' WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE. NUMBER <br /> Wudte Latex Paint tNon-RCRA) <br /> Waste Latex Puint(Non-RCRA) <br /> Wuste Paha Related(Flammables qll hosed) <br /> Waste Paint Related(Flammable,(oil btut:d) <br /> Waste Aerosols Cans <br /> Mnq- ua mc. n 7 1 c <br /> , Dehdr tont mlrwn vJ - <br /> NnmR uunfolu W.A.sntw(sn <br /> nmua.tM-W 1 \llMln• <br /> Waste CorroNIve Liquids.n.o.s. <br /> Waste Flammable Liquids.n.o.s. <br /> Waste Flammable Li uidrs,n,o,s, <br /> Non-RCRA Hazardous Waste,Llqu d <br /> Non-RCRA Hazardous Waste,Liquid <br /> WaetQ Toxic Liquids or SolidN(CI s 9) <br /> Wuste 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 50130 <br /> Glycol Sulk Conc. <br /> TOTAL CHARGES <br /> TSDF <br /> Evergreen 011,Inc. ,IZI CFR <br /> 6880 Smhh Ave. 7321 Wastarn <br /> Newark,CA 94560 Unia City,CA 94587 <br /> CAD930887418 CAL 0091507 <br /> Generstor certifies that It hue established u program to reduce the volume or <br /> Source: ❑Collection St tion Z)Government ^^°+ quantity$toxicity of the hazardous waste to the degree determined by <br /> i]Marine ❑ A ricultural ❑ Industrial geaenttor to be econamlcally 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 Or YOUR OIL„ <br /> Per California Health and Safety Mode Section 25250.9,Evergreen hereby advises customer that customer's shipment of used oil may be <br /> transported to a facility that is requir d 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 pmcess used oil also meet thoFe requirements. <br /> These Include more stringent leak ddtkction and prevention requirements, engineering cetvficadons of tank integrity, and flnancia) assurances for <br /> i closure and accidental releases. It isI wful to send used oil to out-of-state facilities that comply only with federal uRod oil management standards <br /> I, and not these more stringent requirements.This notification is for information purposes only. <br /> I <br /> r <br /> 1 ^ / z/ <br />