Laserfiche WebLink
Evergreen Environmental Services <br /> Containerized Services <br /> dedicated re)the protection ed'aw eijrir(irnjent <br /> To schedule a pickup, call Send payment to: Sales Order <br /> 800-596-9455 Evergreen Oil,Inc. <br /> 6880 Smith Ave..Newark.CA EPA#CAD982413262 Dept.LA 23234 /Z <br /> 16540 S.San Pcdro St..Cannn.CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: /` / <br /> GENERATORIJOB LOCATION BILLING INFORMATION <br /> N l�) NAME GASH❑ CHECK❑ <br /> i # <br /> An SS ADDRESS 'OD <br /> Y STATE C7Co. CiTY STATE ZIP CO. PO# <br /> HONE NOtIr PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> t WAC l..atex Paint(Non-RCRA) <br /> Waste Lata:Paint(Non-RCRA) <br /> Whste Paint Related(Flammables oil rased) <br /> Waste Paint Related(Flammables oil bused) <br /> Waste Aerosols Cans <br /> Nw RCRA HF-"—W.142.SnGd;soil. <br /> newt;conemr.—d;ritL •¢nlaun hvdn u0iur:) <br /> ;m-RCF2A tt:zraxu 1•:aa:.Solid'Soil. <br /> D.vi;annt::minn:ed,vi$, rrmlrumh dio,curhun.;'i <br /> Waste C01TnxiVC Liquids,n-o-s. <br /> Waste flammable Liquids, <br /> Waste Flammable Liquids,n.c.s. <br /> Nnn-RCRA Hazardous Waste,Liquid <br /> Kon-RCRA I tavi.rdous Wauc,i-iquid I <br /> Waste Toxic4.' orSolidx(Class 9) <br /> Waste Oxidizin_Liquids or Solids <br /> Drained Uscd Oil Filters <br /> Empty Drums <br /> Non Harardotis Witer <br /> Non Haeardons\iia to <br /> `Jon Hazard;uls Solids <br /> Not Hazardous Solids <br /> Glycol Bulk 50/50 <br /> Glycol Bulk Cone. I <br /> I- <br /> TOTAI.CHARGES <br /> TSDF 7►7`rc <br /> I1— EvergreenOil.Inc. ❑ SA Rcc <br /> 6880 Smith Avc. 333101Vesterm a L� <br /> Ne.Fark,CA 94560 Union City,CA 94587 <br /> CAD930887418 CALM0344530 <br /> Genu-ator certifies that it ha;eslablishcd a program to reduce the volume or <br /> Source: ❑ Collection Station ❑ Govemment quantity R toxicity of the hurardutus waste to the degree demnnined by <br /> ❑ Marine ❑ Agricultural ❑ lnduia ial generator to he ec:mumiat:lY pnreticabte. . <br /> I herehv certift that I have rend and have the gptltority to <br /> hind the above listed�ener_a_lor to the terms on the reverse <br /> Retain Sample# side of this form. <br /> IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br /> Per California Health and Safety C(Wc Sectinn 25250.9,Rvets:reen hereby advises customer that customer's shipment o1'used oil nlay be <br /> transported to a facility that is required to comply with 1'cdc.al regulations applicable to inanagonient of-used oil.but that is not required to <br /> comply with the)lore strin�Cnt requirements upplic;ible to hazardous waste manadetncnt facilities.Culilornia facilities that handle or process used <br /> oil are required to nicct thou:more stringent rcyuiretnents,and some out-cif-state(tcilitics that process used oil also tnec:t those requirements. <br /> These include more s;t-ingent icak detection and prevention requirements,engineering ccrtitiu ons oft lli intcgiity,and fnanciai assurulCas filo <br /> closure and accidental releases. it is lawful to Send used oil to out-Ur-state 1-acihtics-dw-t C., onl -i federal used oil nianageinent standards <br /> and not these snore suinacnt rcquircnlctlts.This noritication is for information purposes of y <br /> Driver Signature Print Name Route Date Generator's Signature Print Name Date <br /> I <br />