Laserfiche WebLink
WORK ORDER/SERVIC'lE: AGREEMENT <br />./ Evergreen Environmental Services N° 406899 <br />dedicated to the protection of the environment <br />To schedule a pickup, call Send payment to: Sales Order # <br />$00-596-9455 Evergreen Oil, Inc. <br />6880 Smith Ave., Newark, CA EPA# CAD962413262 P -O. BOX 30517 - `.�� <br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Los Angeles, CA 90030-0517 Date: . <br />GENERATORIJOB LOCATION BILLING INFORMATION <br />N A9 r / <br />rf'"'# <br />NAME <br />CASH ❑ CHECK ❑ <br /># <br />DDRES, <br />ADDRESS <br />CU CODE NO, <br />CIV STATE ZIP CO. <br />C►4 �f ok — <br />CITY <br />STATE ZIP CO. <br />PO # <br />PHONE NO. <br />'t —9 <br />PHONE NO. <br />r ) <br />PROFII,E NO. <br />CUSTOMER EPA ID N0. <br />G¢i'_oveZ7� <br />PRODUCT <br />WASTE <br />CODE <br />MANIFEST <br />NUMBER <br />QUANTITY UNITS PRICE <br />AMOUNT <br />Used oil, Non-RCRA Hazardous 1-uhrieating <br />CA <br />ZO;Zl <br />Gal, <br />Waste, Liquid Industrial <br />CA221 <br />Gal, <br />[!Auwmcv�ve A.,ia s,r.. Non-RC1U fluardous <br />Wute aid <br />CA134 <br />Gal. <br />R�� WaMr l'om6useEle LigWa, N.U.S. NA <br />t�� a <br />C'A221 <br />Pni1IAQ2 <br />Gal <br />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />CA221 <br />Gal. <br />Waste Solids and Sludges <br />Gal. <br />Wash Out <br />Each <br />Drained Used Oil Filters <br />Drum <br />Nun-RCRA Hazardous Waste Solids (oily debris) <br />CA223 <br />Chum <br />Empty Drums <br />Drunt <br />Transportation <br />Hrs. <br />Non Hazardous ter <br />Gal. <br />Glycol Bulk 50150 <br />Gal. <br />Glycol Bill Cone. <br />Gal. <br />TEST: Gar D Tcch 41Xx1T.21Lppm ❑ CIor D Tedi 1000 <br />Pass ❑ Fail ❑ Halogen Detectnr/Ranic Te ❑ Pass ❑ Fuil <br />Field Service Work Description: <br />Total Charges <br />Other: <br />Other, <br />Vacuum 5 ices Tillie <br />Out of Y d- On Site Off Site <br />Off Load StartOff <br />Load End Reutm Yard <br />rF <br />F� Consolidated Manifest <br />rgreen Oil, Inc. Evergreen Env. Svc. Evergreen Env, Svc. AJS Filter <br />0 Stnith Ave. 171 Road 3oR El 4139 N. Valentine 15131 Clark Ave. <br />Newark, CA 94560 Davis, CA 95616 Fresno. CA 93722 Industry, CA 91745 <br />CAD980887418 CAD98244,6874 CAD982446882 CA <br />bll(M1097432 <br />❑Evergreec Env. Sv ❑ Evergreen Env. Svc. ❑ CFR CFR ❑ Greenleaf Env. Svc, <br />16604 S. San P 745 A West Bmeravia 944 E. Slauson Ave. 33210 Western 3474 Toyon Circle <br />Carson, CA 90 Santa Maria, CA 93454 Los Anggcics, CA 90011 Union City, CA 94587 Valleyy 5pfloggs, CA 953$2 <br />CAD98l(i CAD982446958 C;121 10021 CALUOW91507 CALA00214411 <br />Generator certifies that it has established a Program to reduce the volume car <br />Source: Collection Station C3Govemment k quantity & toxicity of the huardous wmtc to the degree dstcnnmCd by <br />❑ Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br />I hereby certify that I have read and have the authority to <br />�,.f hind the above listed generator to the terms on the reverse <br />Retain sample #r'� ! G side of this forni. <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 ir; not required to <br />comply with the more stringent requirements applicable to hazardous waste management facilities. Calil'itmia facilities that handle or process used <br />oil are required to ineel those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements. <br />These include more su'ingent leak detection and prevention requirements, engineering certificatiuns of tank integrity, and financial assurances for <br />c osure and accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal aced oil management Standards <br />n not these more stringent requirements. 'this notification is for information purposes only. <br />L, , �. ,4 • l I j7 .V <br />