COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

WORK ORDER/SERVICE AGREEMENT Evergreen Environmental Services N° 402200 dedicated to the protection of the environment To schedule a pickup, call Send payment to: Sales Order # 800-596-9455 Evergreen Oil, Inc. 600 Smith Ave., Newark, CA EPA# CAD982413262 P.O. BOX 30517 7 16540 S. San Pedro St., Carson, CA EPA# CAD62413262 Los Artgelcs, CA 90030-0517 Date:. Z GENERATOR/JOB LOCATION BILLING INFORMATION 11�� t >i 7�'t3 NAME CASH [:]CHECK # ADDRESS f ) / �r�� ADDRESS C S IER ODF NO. /41 C STATE ZIP CO. CITY STATE ZIP CO. -Fo- PHONFUN.O. Aft — 9YIL( PHONE NO. } PROFILE NO. CUSTOMER EPA ID NO. .Z_7�! PRODUCT WASTE CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT Used oil, Non-RCRA Hazardous Lubricating Waste, Liquid Industrial CA7.2ft CA221 q Gal, Gal, U-( A„ fif�. N—ecRA Hu,,,l— Waste i M CA 134 Gal, tiQ Waste CombusuE,b l.gvi4 N.O.S_ NA I IR n cosumina,ed wIN eyo x x'A221 [901/1'W2 Gal. Oil 8t Water, Nun -RCP?. Hazardous waste Liquid CA221 Gal, Waste Solids and Sludges Gal. Wash Out Each Drained Uscd Oil Filters Drum Non-RCRA Hazardous Waste Solids (oily debris) CA223 Drum F.mpty Drums Drum Transportation Hn. Non Hazardous wto Gal. Glycol Bulk 5015(1 Gal, Glycal Bu!/Cone, Gal. TTST: Clor D Tech 40pl&R�ppm Cior Wfech 1000 Paas ❑ Fail ❑ Halogen Detecror(Ramc Test [] P �] Fail Field Service Work Description: Total Char eS Other: Otbcr. Vacuum Services Time Out of d On Site Off Site D'ad Staff O»' lan O Load End Return Yard L 40CA; TS F Consolidated Manifest Evergreen Oil, Inc. ❑Evcrgrecn Env. Svc. ❑ Evergreen Env. Svc. ❑ AJS Filter 5880 Smith Ave. Road 30B 4139 N. Valentine 15131 Clark Ave. Newark, CA 94561) Davis, CA 95616 Fresno, CA 93722 Industry, CA 91745 CAD990887418 CAD982446874 CAD982440382 CAD( ON7432 Evergreen Env, Svc. ❑ Evergreen Env, Svc. 1'—I CFR CFR Wcstcm Greenleaf Env. Svc. 16604 S. San Pcd 745 A west Betteravia l..J 944 E. Slauson Ave, 3474 TQ on Circle Carson, CA 907 Santa Maria, CA 93454 Los Angeles. CA 90011 Union City, CA 94587 Valleyy Syppnaggs, CA 95352 CA179816Ni4 CAI)982446858 C.AI pO0110021 CAL(Xl()091547 CAL0002144t 1 Generator cer'lifto that it has established a program to reduce the volume or Source: Collection Station 0 Government quantity h2 toxicity of the hazardous waste to the degree determined by ❑ Marine p Agricultural C1 Industrial generator to be economically practicable. I he vby certib that I have read and have the authority to Wind the above listed generator to the terms on the reverse Retain sample # ''� G! side or this form. IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. Per California Health and Safety Code Section 25250.9, Evergreen hereby advises customer that customer's shipment of used oil may be Lransportctl to a facility that is required to comply with fcderal regulations applicable to management of used oil, but that is not requircil to comply with the more stringent rcquircrnenta applicable to hazardous waste management facilities. California facilities that handle or process used oil are required to meet those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements. 'These include more stringcnt leak detection wid prevention requirements, engineering ceriitications of tank integrity, and financial assurances lar 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 nd n<?t these mon stringcnt requirements. This notification is for information purposes only. [Or t J L 7n3® C, -7,!D-7 % Nt,1 Y \% %_%.,n..