COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

WORK ORDER/SERVICE AGREEMENT l Evergreen Environmental Services N° 406962 dedicated to the protection of the environment To schedule a pickup, call Send payment to: Sales Order # 800-596-9455 Evergreen Oil, Inc. 6880 Smlth Ave., Newark, CA EPA# CAD982413262 P.O, BOX 30517 16540 S. San Pedro SL, Carson, CA EPA# CAl)982413262 Los Angeles, CA, 90030-0517 Date: • L -b7 GENERATORIJOB LOCATION BILLING INFORMATION PRODUCT r NAME UNITS PRICE AMOUNT CASH ❑ CHECK D CA22 �i6i�.iif Gal. Waste, Liquid Industrial CA221 ADDRESS Gab ADDRESS CA134 CUSTE (SDE NO. Gal, R Wy,y eanbusdbie L.IaY1d, N.n. S. NA IY93 Il[ II mn•d� I hdo a CA:2l Y1X11l1'Up2 Ga). CITY STATE ZIP CO. CITY STATE ZIP Co. PO # PRONE NO. PHONE NO. Wash Out PROFILE NO. CUSTOMER EPA ID NO. 8— Drained Used Oil Filters )�OoQrAr/ DL-trm Non-RCRA Hazardous Waste Solids (oily debris) PRODUCT WASTE CODE MANIFEST QUANTITY NUMBER UNITS PRICE AMOUNT Used oil, Non-RCRA Hazardous Lubricating CA22 �i6i�.iif Gal. Waste, Liquid Industrial CA221 Gab Urea Au,o to Antirrwea, NonRCRA 11mxdws Wn id CA134 Gal, R Wy,y eanbusdbie L.IaY1d, N.n. S. NA IY93 Il[ II mn•d� I hdo a CA:2l Y1X11l1'Up2 Ga). Oil bt Water, Non-RCRA HaLudous Waste Liquid CA221 Gal. Waste Solids and Sludges Gal, Wash Out Each Drained Used Oil Filters DL-trm Non-RCRA Hazardous Waste Solids (oily debris) CA223 Drurtl Empty Drums Dntm Transportadon Hr's. Non Hazardous ater Gal. Glycol8ulk 50/50 Gal. Glycol Bu Conc, Gal. TEItiT; Z Clor D'Tech 4ow2=Lppm 0 Clur D'I'ech IOW Pass [D Fail 0 Halogen Detector/Fhune Test Pa51% Q Fail Field Service Work Description: Total Charges Other. Other: Vacuum /vices Time Out of tud On Site Off Site Off Lnad Start Off Load End Return t and (rC%A- ,.� TSF [� Consolidated. Manifest 11 Evergreen oil, inc. Evergreen Env. Svc. Evergreen Env. Svc. L AJS Filtcr 6884) Smith Ave. R 30H 4139 N. valentine L..J 15131 Clark Ave. Newark, CA 94560 Davis, CA 95616 Fresco, CA 93722 Industrryy CA 91745 CAD990987418 CAD'JV446874 CAD982446982 CADO()0097432 L1Evergreen F,nv. S Evergreen Env. Svc. CFR ❑ CPR � Grccnlcaf Env. Svc, I_l 16600 S, San P ro 745 A West Betteravin 944 E. Slaucon Avc. 33210 Westert 3474 Taynn Circle Carson, CA 9 445 Santa Maria, CA 93454 Loa Angeles, CA 91X)11 Union City, CA 94587 Valley Springs, [A 95352 CAD98169f 0 CAll982446858 CAL(W IIW21 CAL000091307 CALLU0214411 Generator certifies that it has established a program to reduce the volume or Source: Collection Station ❑ Government quantity & toxicity of the hazardous waste to the degree dctcmuned by ❑ Marine ❑ A 'cultural U Industrial generator to be- economically practicable. I hereby certify that I have read and have the authority to bind the above listed generator to the terms on the reverse Retain sample # 3 e— 4 side of this form. IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OTT_ Per California Health and Safety Code Section 25250.9, Evergreen hereby advises customer that customer's shipment of used oil may be mansportcd to a facility that is required to comply with federal regulations applicable to management of used oil, but that is not required to comply with the more stringent requirements applicable to hazardous waste management facilities, California facilities that handle or process used oil are required to meet those more stringent "uiretnents, and some out-of-state facilities that process used oil also meet those requirements, Ty e include morc stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances fur cl s ire and accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards d not these more stringent requirements. This notification is for information purpos s only, 1 41L, nL 7 _�;8 Ll -Dl a r � -t—vXkA_k0__