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21 <br />Evergreen Ei?i- mental Services <br />Containe Services <br />dedicated to the protec ton of the etzrlrotvnetzt <br />4w To schedule a pickup, call Send payment to: <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 <br />GENERATOR/JOB LOCATION BILLING INFORMATION <br />No <br />Sales Order #� <br />Date <br />N <br />NAME <br />CASH E] CHECK <br />DRES6 <br />ADDRESS <br />CUSTOMER CODE NO. <br />CITY, 'STATE <br />ZIP <br />CO. <br />CITY <br />STATE ZIP CO. <br />PO # <br />:PHONE NO. <br />PHONE NO. <br />PROFILE NO. <br />CUSTOMER EPA ID NO. <br />r _ <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. (Flammables oil based) <br />Waste Paint Related (Flammables oil based) <br />Waste Aerosols Cans <br />Non-RCRA Hazardous Waste, Solid (Soil, <br />Debris contaminated with petroleum hydrocarbons) <br />Non-RCRA Hazardous Waste, Solid (Soil, <br />Debris contaminated with petroleum hydrocarbons) <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, 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 Recycling ❑ <br />6880 Smith Ave. 33210 Western <br />Newark, CA 94560 Union City, CA 94587 <br />CAD980887418 CAL000344530 <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 ❑ Agricultural ❑ 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 />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 ore stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for <br />closure apdAaccidentahrelcases. It is lawful 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 />