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Evergreen Envim-mental SeeM--Aces Per Containerized Services <br /> dedicated to the protection of the environmentTo schedule a pickup, call Send payment to: aX <br /> 800-596-9455 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 RO.BOX 30217 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles,CA 90030-0517 Date: v <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NAM / NAME CASH CHECK <br /> �SSQ ADDRESS 0 R COD N0. <br /> �/ <br /> Cr.. ST E gE M. CITY STATE ZIP CO. PO# <br /> PHO N / PHONE NO. PROFILE NO. CUSTOMER EPA M NO, <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 H—dous Waste,Sold(Soil, e - i <br /> Debris contaminated with mtra cum h mcarbons) <br /> Non-RCRA Hazardous Waste,Solid(Soil, <br /> Debris contaminated wish troleumh droearbons <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 F' ers <br /> Empty Drums <br /> Non Hazardous Mater <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. FR <br /> 6880 Smith Ave. ,33210 Western i(�L� �� ' CCC JJJ�)J CCCJJJ <br /> Newark,CA 94560 Union City,CA 945 �^r <br /> CAD980887418 CAL000091507 9Qjs <br /> Source: ❑ Collection Station ❑Government Generator certifies a tt s to lis e e program to reduce the volume or <br /> 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 /> Retain sample# s n of this above <br /> listed generator to the terms on the reverse <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 isnot 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 these more stringent uirements.This notification is for information purposes only. <br /> T_. rT. LT_..__ T\_�_ <br />