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Evergreen Eni amen <br /> cal Services <br /> Containerized Services <br /> dedicated ru rhe protection of the environment <br /> To schedule a pickup, call Send payment t4: <br /> Sales Order# <br /> 800-556-9455 Evergreen Oil,Inc. <br /> 6850 Smith Ave.,Newark,rA EPA#CA0982413262 Dept.LA 23234 <br /> I M-a S.San Pedro St.,Carson,CA EPA#CA-0982413262 Pasadena,CA 91195-3234 Date <br /> C7✓NERATOR/JOB LOCATION BILLING INFORMATION <br /> NAM NAME <br /> . CASH El CHECK <br /> ADD 7 AnDILESS # „ <br /> Cl()sTOMER CODE No. <br /> CITY SATE ZIP CO. CITY STATE 7IP CO. PO# <br /> PIIpN NO, PHONE NO, PRQFII E NO. CUSTOWR EPA Ib NO. <br /> PRODUCT WASTE 1VIA_NIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOONT <br /> Waste Latex paint(Non-RCRA) <br /> Waste Latex Paint(Non-RCRA) <br /> Waste Pain[Related(Flsarlmables oil based) <br /> Waste faint Related(Flammables oil based) <br /> W4ste Aerosols Cans <br /> NOn- A Fl;dard0ui p,(C.SA d($oil. <br /> DLu WJ11Y)Ld wiN)WOI&—h(WW0 rho,jx) <br /> Nan•R i.A Aldous de,st)a( . <br /> Dmriaon);u:iuuted with uo4ua)h <br /> Waste Corrosive Liquids,n.os. <br /> waste Flammable Liquids,n.o.s. R NMENTAL HEAL <br /> Waste Flammable Liquids,n.o.s, PE MIT/SERVICE <br /> Non-RCRA Hazardous Wuste,Liquid <br /> Non-RCRA Hazardous Waste,liquid <br /> Wasic Toxic Liquids or Solids(Class 9) <br /> Walde Oxidizing Liquids or Solids <br /> Dfainad Used Oil Filters <br /> Empty Drums <br /> Non Ha2ardous Water <br /> Nat Hazardous Water <br /> Non Hazardous Solids <br /> Non 14azardous Solids <br /> Glycol Bulk 50150 <br /> Glycol Bulk Conc, <br /> TSDF TOTAL CHARLES <br /> { Evergreen Oil,Inc. (—I SA Recycling <br /> u 6880 'ten <br /> Ave, L—J 33210 Wes[ern (�%•v�Y' <br /> Newark,CA 94560 Union City,CA 94587 ^ <br /> CAD980887418 CAL0003445301� <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: ❑ Collection Station Q CrOVL'rrulleIlt <br /> quantity&toxicity of[he hazardous waste to the degree determined by <br /> ® Marine Q Agricultural ❑ Industrial generator to be economically practicable. <br /> Thereby c 9jb that I h*ye regd and hraye the a�thority�o <br /> RetB.ICI Sample# bind the above fisted geggrator the terms on the averse <br /> side his form, <br /> PORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OrL. <br /> Per California Health and Safety Code Section 25254.9,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 arc 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 accideDn es.It is lawful to send used oil to out-of-state facilities that eornply only with federal used oil management standards <br /> and not t ore stringent cquirements,This noti scion is for information purposes nly. <br /> Driver Sign re -nt l.�ame <br /> RotDte# Date Pn t Name ri;ttP <br />