COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

,.f Evergreen Environmental Services tlp �;'� dedicated to the ,ction of the environment N-0 6 4 6 I� . To �� schedule a pickup, call Send payment te. 8Sales Order# " �� ,f 00-596-9455 Evergreen Oil,Inc. 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 GENERATOR/JOB LOCATION Date: BILLING INFORMATION N cc�� NAME r1L v L CC> CASH❑CHECK ADDRESS ADDRESS # 101 ito -5Q,- -% �— CU TOMER CODE NO. CITY STATE ZIP CO. CITY SIATE ZIP CO. PO# H� 3 PHONE NO. PHONE NO. PROFILE NO.lcf-i CUSTOMER EPA ID NO. ( ) �s- PRODUCT WASTE MANIFEST _— CODE NUMBER QUANTITY UNITS PRICE AMOUNT Used oil,Non-RCRA Hazardous Lubricating CA22 14.Y S Gal. Waste,Liquid ze,Non RA Hazardous Industrial CA221 Gal d Autonative Antifree -RCCA 134 Li uid RQ Waste Combustible Liquid,N.O.S.NA CA2�1 - Gal - 1993 m(Oil...taminated with Mogens) FOCA1002 Gal. Oil&Water,Non-RCRA Hazardous Waste Liquid CA223 Gal Non Hazardous Water R Gal. Waste Solids and Sludges Gal. — Wash Out Each Pressure Washer/Steam Cleaner Day Transportatiait -- Hrs. Fuel Surcharge Glycol Bulk 50/50 pecify Product Gal Glycol Bulk c./Specify Product Gal. TEST: Cl,, a Tech 4000L�` ppm El Clor D Tech 1000 Pass Fail Retain Sample#.. !� Total Char es Re uirea @ Field Service Work Description: --- Other: Other: TSD Consolidated Manifest DRIW CK,fSTi' Evergreen Oil,Inc. ❑ Evergreen Oil,Inc.-DavisEvergreen Oil,Inc.-Fresno ❑ Time In 6880 Smith Ave. Road 30B ❑4139 N.Valentine Time Out Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 ❑ Tank/Drum Properly Labeled CAD980887418 CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked ❑ Evergreen Env.Svc. ❑ EmvTm0i4 -SantaMana ❑ House Keeping-Tank/Drum Clean Carson, S.San Pedro 745 ASana Maria, CA 9 45 ❑ ❑ Other Services Checked: ❑Oil, ❑ Filters/Drums, ❑Antifreeze Carson,CA 9074 Santa Maria,CA 93454 CAD9816964 CAD982446858 ❑ Called in other services needed ❑Oil, Ei Filters/Drums, Antifreeze Source: Collection Station ❑Government Generator certifies that it has established a program to reduce the volume or quantity&toxicity of the hazardous waste to the degree determined by ❑Marine ❑ Agricultural ❑ IndusLial generator to be economically practicable. I hereby certify that I have read and have the authority to bind the above fasted generator to the terms on the reverse side of this form. IMPORTANT NOTICE REGARDING TIME 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 transported 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 quired to meet those more stringent requirements,and some out-of-state facilities that process used oil also meet those requirements. Thes ' clude more stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for clos r d accidental releases.It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards an these more stringent requirements.This notification is for information purposes only. river Signature Tint Name Route# Date enerator's S' ure Print Name Date �a,�:._ --- - - _. _ .. .. _