Laserfiche WebLink
1 WORK ORDSERVICE AGREEMENT <br /> Evergreen Envithmental Services N� Q 91. 5 6 2 <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: Sales Order # <br /> 800-596-9455 Evergreen Oil, Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 P.O. BOX 30517 <br /> 16540 S. San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles, CA 90030-0517 Date: <br /> GENERATOR/ OB LOCATION BILLING INFORMATION <br /> NAMENAME CASH❑ CHECK❑ <br /> # <br /> �D ADDRESS CUSTOMER CODE NO. <br /> T • STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> PHONE NO. PROFILE NO. CUSTOMER EPA ID N0. <br /> ( ) <br /> PRODUCT HASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Used oil,Non-RCRA Hazardous Lubricating CA22 3 i Gal. <br /> Waste,Liquid Industrial CA221 Gal, <br /> Waue Li,mtlo,w,Amift em.Non-RCRA Hom,tloue CA134 Gal. <br /> Re Wnsta CambuvibN Liquitl,N O.S.NA CA221 <br /> ivsa m tri.�...anend,ea.vim nam nn: rrool/Fooz Gal. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Drained Used Oil Filters Drum <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum <br /> Empty Drams - Drum <br /> Transportation <br /> Hrs. <br /> Non Hazardous W r Gal. <br /> Glycol Bulk 50150 Gal. <br /> Glycol Bulk Cone. Ga <br /> TEST:pIrclor D Tech 4007-4111zlppm ❑Clor D Tech 10001 alogen Detector/Hama est ❑Pass ❑Fail <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum Se s Time <br /> Out of Y d On Site Off Site Off Load Start Off Load End Return Yard <br /> TS Consolidated Manifest <br /> Evergreen Oil.Inc. � Evergreen Env, Svc. ❑ Evergreen Env.Svc. � A15 Filter ❑ <br /> 6880 Smith Ave. Road 308 4139 N.Valentine 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95fi16 Fresno,CA 93722 Industry,CA 9]745 <br /> CAD980887416 CAD982446874 CAD982446882 CAD000097432 <br /> Evergreen Env.Sv ❑ Evergreen Env.Svc. CFR CFR ❑ Greenleaf Env.Svc. <br /> 16604 S.San P 745 A West Betteravia 944 E. Blouson Ave. 33210 Weatem 3474 Tryon Circle <br /> Carson,CA 90 6 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD98169 CAD982446858 CAL000110021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: lCollection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> Retain sample #3 C� i itt bind the above listed generator to the terms on the reverse <br /> side of this form. <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 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 meet those requirements. <br /> ese inclmore stringent leak detection and prevention requirements,engineering certifications of tank integrity, and financial assurances for <br /> lure and ude accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> %not these more stringent requirements. This notification is for information purposes only. <br />