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Evergreen Envi r>l 6nta$ aervrc s <br />Container zed Services <br />dedicated to the protection of the environment <br />To schedule a pickup, call Send payment to: <br />800-596-9455 Evergreen Oil, Inc. <br />Sales Order #,/%-`%'"y <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 />NAME <br />C L ,Eiij/.a�I <br />NAME <br />CASHE] CHECK E] <br /># <br />ADDDRESSS/ <br />ADDRESS <br />CUSTOMER CODE NO. <br />CITY STATE ZIP CO. <br />CITY <br />STATE ZIP <br />CO. <br />PO # <br />PHONE NO. <br />PHONE NO. <br />PROFILE NO. <br />CUSTOMER EPA ID N0. <br />PRODUCT WASTE <br />CODE <br />MANIFEST <br />NUMBER <br />QUANTITY UNITS <br />PRICE AMOUNT <br />Waste Latex Paint (Non-RCRA) <br />Waste Latex Paint (Non-RCRA)t' <br />Waste Paint Related (Flammables oil based) <br />Waste Paint Related (Flammables oil based) <br />Waste Aerosols Cans <br />Non-RCRA Hazardous Waste, Solid (Soil. <br />Debris conmminated with etmleum hydrocarbons) <br />Non-RCRA Hazardous Waste, Solid(Soil, <br />Debris contaminated with ttoleum h drocarbons) <br />Waste Corrosive Liquids, n.o.s. <br />zj <br />Waste Flammable Liquids, n.o.s. �? / <br />Waste Flammable Liquids, n.o.s. <br />Non-RCRA Hazardous Waste, Liquid <br />Non- zard u Waite, LWuid <br />% <br />1 <br />Wast or Soli (Class 9)/ <br />Waste Oxidizing Liquids or Solids <br />Drained Used Oil Filters <br />Empty Drums} <br />NonHazardous Water <br />" <br />Non Hazardous Water <br />Non Hazardous' Solids <br />Non Hazardous Solids <br />Glycol Bulk 50150 <br />Glycol Bulk Conc. <br />TSDF <br />Evergreen Oil, Inc. SA Recycling El <br />6880 Smith Ave. 33210 Western <br />Newark, CA 94560 Union City, CA 94587 <br />CAD990887418 CAL000344530 <br />Source: ❑ Collection Station ❑ Govemment q <br />❑ Marine ❑ Agricultural ❑ Industrial ri <br />Retain Sample #. <br />TOTAL CHARGES <br />,nerator certifies that it has established a program to reduce the volume or <br />lantity & toxicity of the hazardous waste to the degree determined by <br />nerator to be economically practicable. <br />hereby certify that I have read and have the authoJt <br />bind the above listed generator to the terms on the reverse <br />side of this form. <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 not thesemore sfr ngent requirements. This notification is for information purposes only. <br />C.� <br />