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CITY
<br />5
<br />CODE
<br />-r.
<br />1
<br />WORK 04MERVITCEkGREENTENT
<br />. Evergreen Envi ental Services
<br />dedicated to the protection of the environment
<br />O4 4 I
<br />To schedule a pickup, call Send pay e t to:
<br />800-596®9455
<br />Sales Order #
<br />Evergreen Oil, Inc.
<br />6880 Smith Ave., Newark, CA EPA# CAD982413262 Dept. LA 23234
<br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Pasadena, CA 91185-3234
<br />OE'NERATOR/,IOB LOCATION
<br />Late -
<br />BILLING INP'O,_ATION
<br />MANIFEST
<br />NAME
<br />MD
<br />SS
<br />CITY
<br />5
<br />CODE
<br />-r.
<br />1
<br />Fuel Surcharge
<br />Glycol Bulk 50/50/Specify Product
<br />Glycol Bulk Conc./Specify Product _
<br />TEST: ❑ Clor D Tech 4000 ppm ❑ Clor D Tech 1000 ❑ Pass ❑ FaiI [j Pass ❑ Fail
<br />®Retaftri sanale # r44Wired
<br />rvice Work Descriptions -1
<br />I
<br />HIS.
<br />Gal.
<br />Gal.
<br />Total
<br />❑ y a
<br />TSDConsolidated Manifest
<br />DRIVER CHECKLIST
<br />Evergreen Oil, Inc. Evergreen Oil, Inc. - Davis Evergreen Oil, Inc. -Fresno t
<br />ti 688G Smith Ave. ❑ Road 30B ❑ 4139 N. Valentine f7 Time In Time Out
<br />-Newark, CA 94560 Davis, CA 95616 Fresno, CA 93722 Tank/Drum Properly Labeled
<br />CAD980887418 CAD982446874 CAD982446882
<br />❑Accumulation Start Date Marked
<br />Evergreen Env. Svc. Eie:'gee11CiLk.-SantaMara❑ House Keeping - Tank/Drum Clean
<br />16604 S. San Pedro ❑ 745 A West Betteravia
<br />rs
<br />Caon, CA 90746 Santa Maria, CA. 93454 L7 Other Services Checked: ❑ Oil, O FiIters/Drums, G Antifreeze
<br />CAD981696420 CAD982446858 I i Called in other services needed ❑ Oil, ❑ Filters/Drums, ❑ Antifreeze
<br />Source: �OIiCCt1oTI StationGOt eI�lIT e / o Generator certifies that it has established a program to reduce the volume or
<br />nt quantity & toxicity of the hazardous waste to the degree determined by
<br />C1 Ma€Ine Q A cultural , J Industrial generator to be economically practicable.
<br />I hereby certiz`v that I have read and have the authorhy to
<br />bind the above listed generator to the terms on the reverse
<br />side or tilts `ort.
<br />IMPORTANT NOTICE RECARJUDINO THE DISPOSITIONT OF TOUR (III,.
<br />:Per California Heald_ and Safety Code`See¢tori 2525€1,9, Evergreen hereby advises customer that customer's shipment of used oil may be
<br />w�s❑rtedto a ih the facility
<br />that rmaiS required to comply} With federal regulations applicable to management of n.et,ri nil, brit that ;� ,at rec�Liirad to
<br />1i gent requur er s 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 />These include more stringent leak detection and prevention requirements; engineering certifications of tank integrity, and financial assurances for
<br />closure and accidental releases. It is lawful to send used oil to out-of-state facilites that comply only with federal used oil management standards
<br />and not thcsc niore stringent requirements. This notification is for information purposes only.
<br />r'
<br />t
<br />Y
<br />f
<br />PROFILE NO.
<br />CUSTOMER EPA ID NO.
<br />�
<br />PRODUCT
<br />WASTE
<br />MANIFEST
<br />COBE
<br />NUMBER
<br />QUANTITY
<br />UNITS
<br />PRICE AMOUNT
<br />Used oil, Non-RCRA Hazardous ALubricating.
<br />CA221 �`e
<br />;
<br />Gal.
<br />Waste, Liquid Industrial
<br />CA221
<br />f <{
<br />Used Automotive Antifreeze, Mon-RCRA Hazardous
<br />Gal.
<br />wasw Uquid
<br />CA134
<br />Gal
<br />RQ Waste Combustible Uquid, N.O.S. NA
<br />1993 ni{Oil contaminated with halo>ens)
<br />CA221
<br />F001/F002
<br />_
<br />Ga
<br />Oil & Water, Non-RCRA Hazardous Waste Liquid
<br />CA223
<br />Non Hazardous Water
<br />Gal.
<br />Waste Solids and Sludges
<br />Gal.
<br />Wash Out
<br />Gal.
<br />Pressure Washer/Steam Cleaner
<br />Each
<br />Fuel Surcharge
<br />Glycol Bulk 50/50/Specify Product
<br />Glycol Bulk Conc./Specify Product _
<br />TEST: ❑ Clor D Tech 4000 ppm ❑ Clor D Tech 1000 ❑ Pass ❑ FaiI [j Pass ❑ Fail
<br />®Retaftri sanale # r44Wired
<br />rvice Work Descriptions -1
<br />I
<br />HIS.
<br />Gal.
<br />Gal.
<br />Total
<br />❑ y a
<br />TSDConsolidated Manifest
<br />DRIVER CHECKLIST
<br />Evergreen Oil, Inc. Evergreen Oil, Inc. - Davis Evergreen Oil, Inc. -Fresno t
<br />ti 688G Smith Ave. ❑ Road 30B ❑ 4139 N. Valentine f7 Time In Time Out
<br />-Newark, CA 94560 Davis, CA 95616 Fresno, CA 93722 Tank/Drum Properly Labeled
<br />CAD980887418 CAD982446874 CAD982446882
<br />❑Accumulation Start Date Marked
<br />Evergreen Env. Svc. Eie:'gee11CiLk.-SantaMara❑ House Keeping - Tank/Drum Clean
<br />16604 S. San Pedro ❑ 745 A West Betteravia
<br />rs
<br />Caon, CA 90746 Santa Maria, CA. 93454 L7 Other Services Checked: ❑ Oil, O FiIters/Drums, G Antifreeze
<br />CAD981696420 CAD982446858 I i Called in other services needed ❑ Oil, ❑ Filters/Drums, ❑ Antifreeze
<br />Source: �OIiCCt1oTI StationGOt eI�lIT e / o Generator certifies that it has established a program to reduce the volume or
<br />nt quantity & toxicity of the hazardous waste to the degree determined by
<br />C1 Ma€Ine Q A cultural , J Industrial generator to be economically practicable.
<br />I hereby certiz`v that I have read and have the authorhy to
<br />bind the above listed generator to the terms on the reverse
<br />side or tilts `ort.
<br />IMPORTANT NOTICE RECARJUDINO THE DISPOSITIONT OF TOUR (III,.
<br />:Per California Heald_ and Safety Code`See¢tori 2525€1,9, Evergreen hereby advises customer that customer's shipment of used oil may be
<br />w�s❑rtedto a ih the facility
<br />that rmaiS required to comply} With federal regulations applicable to management of n.et,ri nil, brit that ;� ,at rec�Liirad to
<br />1i gent requur er s 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 />These include more stringent leak detection and prevention requirements; engineering certifications of tank integrity, and financial assurances for
<br />closure and accidental releases. It is lawful to send used oil to out-of-state facilites that comply only with federal used oil management standards
<br />and not thcsc niore stringent requirements. This notification is for information purposes only.
<br />r'
<br />t
<br />Y
<br />f
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