COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

�.. WORK ORDEII.dERVICE AGREEMENT Evergreen Environmental Services NO- 440550 dedir'nred m rhe Prnrrnlan aJ'the em-h-on nenr -- To schedule a pickup, call Send payment to: Sales Order# 800-596-9455 F.vcrgmen Oil. Inc. 6880 Smith Ave.,Newark,CA EPA#CAD982413262 P.G. BOX 30517 16540 S.San Padre St..Careen,CA EPA#OADS82413262 Lott Angeles.CA 90030-0517 Date: GENERATOR/JOB LOCA'T'ION BILLING INFORMATION N: ME NAME CASH❑CHECK❑ p ADDRESS ADDRESSCUSTOMER CODE:NO. CAPjr CITti' STATE ZIP CO. CITY STA'1'li ZIP CO. PO# CA O PHONE; NO, PHONE: NO. PROFILE NO, CUSTOb1ER EI'A ID NO. PRODUCT H'AS'TE MANIFEST QUANTITY UNITS PRICE AMOUNT CODE NUMBER Used ail.Nun-RCRA Hlminlous Lubricating CA22jjD, Exp,'I Cil. Waste,Liquid Indusaial CA221 Gal. L',u I: W Aiw —1.1T.—.i.—.Mw RCR4 nvv,Lwn CA 134 Gal. N'w R(1 N'asm Cmmlw.,iFla I i4Ml\.n.5.,W\ C\P_I Gal. ITq 1,1 nil annionnonul vnL hvM,ceml I4MfN41M4' Oil&Water.Non-RCRA Hazardous Wane Liquid CA221 Gal. Waste Solids and Sludges Gal. Wash Out Each Drained Used Oil Filters Drum Non-RCRA HwArdous Waste Solids(oily debris) CA223 Drum Empty Drums Drum Trnnsp,alation Hrs. Non Hazardous Water Gal. Ghv-ol Bulk StV50 Gal. Glraa dol' Cone. Gal. TEST: Clor D Tech 40 02( ppm ❑Clor D Tech 1000 pass❑Feil ❑ Halogen tkuelor/name Test W.Iss ❑ Fail Field Service Work Description: Total Charges CNher: Other: Vacutuu Services Time Out of arJ On Site Olf Site Off Load Sian Off 1_oad End L\ten In Ymd TSF Consolidated Manifest Erergrecn Oil.Inc. ❑ F%Crerecn Env.Svc ❑ Erergrecn Enc.SIL. E] AIS Filer ❑ 68SO Smith Ave. Road 3611 4139 N.Valena,u 15171 Clark Ave. Nawark.CA 945011 Davis.CA 9561(, Fresno.CA 97722 Wn.,u).CA 91745 .. _.. CAD98(%87418 CAD98244fiS74 CAD"2-146R82 CAD000W7432 ❑ Evergreen Ens•.Svc. ❑ Erergrecn B,s'.Svc. ❑ CFR O Crl2 ❑ Greenleaf Env.Sm. 16W4 S.Som Pula 745 A Wcsl Beuerarm 944 F.Slausnn A,c. 33210 Wrestern 3474 To-yon Circle Carson.CA JO7746 Santa\1:aia.Cil 93454 Los Angeles.CA 10111 Union City.CA 94537 Valle,Springs.CA 95352 CAM fig( 11 CAD982446858 CAL000110021 CALOW1091507 CAL00021"]1 (ienemmr catilles that it Ilan caAilished a fragrant to reduce the Volume or Source: lCollection Station O Government quantity S toxicity of the haz;udous N'amc m the s ,tnve determined by C] Tndusu'ial eencr.&u m Iv«nnnnia:d pracncAle ❑ Marine ❑ Agricultural hercbv certify that I have read and hire the authority to hind the above listed generator to the terms on the revere Retain sample #7 (r— ze side of this form. IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. Per California Health and Safety Code Section 25250.9, Evergreen hereby ad%i,es cuslomer that customer's shipment of used oil may be transported to a facility dun is required to comply with tederal regulations applicable to management of used oil, but that is not required to conifth with the more stringent requirements applicable to hazardous waste nlanagenlent facilities. California facilities that handle or process used ui 'Ire required h, meet tlwse more stringent reluilernen15. and some oul-of-stale facilities mreq that process used nil also meet those uirement.. ,z e include more arineent leak detection and prevention rcquiremenu, engineering certiticatioos of tank integrity,and financial assurances for los re and accidenud releases It is lawful to send used nil to out-ol'-state facilities that comply only with federal used oil management standards and lot these nuna suiu,_etu requirements. this nulilication is for inlilrnanion propose.only. I 'iter Si_m;durc rine Nim)" Rollie 4 Dene GcnAvioi's Signature Print Name D;nc 01 -d 4802LL11s602 HIN 3d3WtWI-1 UOZHW WAIS dL012T 80 Se dOS