Laserfiche WebLink
WORK ORDE,R/SERVICE, AGREEMENT <br />Evergreen Environmental. Services <br />dedicated to the protection of the environment <br />To schedule a pickup, call <br />800-5969455 <br />6880 Smith Ave., Newark, CA EPA#' CAD962413262 <br />16540 S. San Pedro St_, Carson, CA EPA# CAD962413262 <br />GENERATOR/JOB LOCATION <br />Send payment to: <br />Evergreen Oil, Inc. <br />P.O. BOX 30517 <br />4os Angeles, CA 90030.0517 <br />BILLING INFORMATION <br />N2394870 <br />Sales Order # <br />Date- 3 • Z.a - --.,.-7 <br />NALME- A - <br />f�,, <br />NAME <br />CASH ❑ CHECK ❑ <br /># <br />Ab DRESS <br />ADDRESS <br />CWitCODE} NO. <br />CITY STATE ZIP CO. <br />CITY <br />STATE ZEP CO. <br />PHONE NO. <br />2 <br />PHONE NO. <br />PROFH F, NO. <br />CUSTOMER EPA ID NO. <br />7 fir <br />PRODUCT' WASE <br />CODE <br />MANIFEST <br />NUMBER <br />QUANTITY UNITS PRICE, <br />AMOUNT <br />Used oil, Non-RCRA Hazardous Lubricating CA221 <br />7,id <br />Gal. <br />Wastc, Liquid Industrial CA221 <br />Gal. <br />UtaAeuto!:l Anda—.. Nn-RCRA KV.Ww CAI 34 <br />Wg'A.- <br />Gal. <br />114WCn,•PueiiMla Liyuw{, N.O.S. NA CA22t <br />t i m at �oa,.ado.Qe w>N t.L'. POO IIRM <br />Gal, <br />Oil & Water, Non-RCRA Hazardous Waste Liquid CA221 <br />Gal, <br />Waste Solids and Sludges <br />Gal. <br />Wash Out <br />Each <br />Drained Used Oil Filters <br />Drum <br />Non-RCRA HaZanious Waste Solids (oily debris) CA223 <br />Drum <br />Empty Drums <br />Drum <br />Transportation <br />Hrs, <br />Non Hazardous W <br />ZGal_ <br />Glycol Bulk 40150 <br />Gal. <br />Glycol Bulk Conc. <br />Gal. <br />TEST: (Clor D Tech 4000-2A.'Qppm ❑ Clor I) Tech 1000 <br />Pags ❑ Fail ❑ Halogen Detmtr/Flame Test ❑ Pas. Fail <br />Field Service Work Description: <br />Total Charges <br />Other. <br />Other:. <br />Vacuum Spevices Time <br />Out of Cin Site Off Site Off Load Son <br />Off Load End Return w Yar <br />ta <br />Consolidated Manifest <br />rgreen Oit, Inc. Ever�run linv, Svc. ❑ Evergreen Eitv, Svc. , AIS Filter ❑0 Smith Avc. ❑Road 30B 4139 N. Valentine . 15131 Clark Ave. <br />Newark, CA 94560 Davis, CA 95616 Fresno. CA 9372'2 Industry, CA 91745 <br />CAD9140897418 /' CAD982446874 CAWN2446852 CAD000097432 <br />❑ Evergreen E ` nv. Evertm Env, Svc, ❑ CFR <br />166W S. san Ll <br />A Wcst Bcuuavia 944 E. <br />Carbon, CA9V740 Santa Maria, CA 9 145 Los N <br />10021 <br />Source: CA Collection Station J Government <br />Q Marine ❑ Agricultural ❑ Industrial <br />❑ CFR ❑ Greenleaf Cnv. Svc. <br />Ave. 33210 Wester 3474 Toyon Circle <br />A M)I I Union City, 07 94587 `allay Spr' i CA 95352 <br />Generator certifies that it has established a program to reduce the volume or <br />quantity & toxicity of the hazardous waste to the degree determined by <br />generator to be econontically practicable. <br />1 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 # G T side of this [orm. <br />IMPORTANT NOTICE REGARDING THE DISPOSrI ION OF YOUR OIL. <br />Per California Health and Safely Code Section 25250.9, Fvergrcen hereby advises customer that customer's shipment of used oit may he <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 rncet thusc requirements, <br />c include mgrs stringent leak detection and prevention requirements, cngineering certifications of tank integrity, and financial assurances for <br />cl st m 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 />a tot these more stringent rcquirr.ments. This notification is for information purpo' s only. <br />