COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

.% WORK ORDERISERVICE AGREEMENT Evergreen Envir0inental Services '® 555585 dedicated to the protection o.0he (,in ironment To schedule a pickup, call Send paNnient to: Sales Order # oZ�` 800-596-9455 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 Date: ')uni ,t -c' ,ENERATOR/JOB LOCATION BILLING INFORMATION IF, s QUANTITY UNITS PRICE NAME Used oil, Non-RCRA Hazardous Lubricating CASH [:] CHECK Gal. Waste, Liquid Industrial CA221 Gal. # ADD ES I G31. ADDRESSCU RQ Waste Cmnbustible Liquid, N-O.S_ NA 1993 in (Oil c 1—mated seal, haloeea) 0�11E O s Oil & Water, Non-RCRA Hazardous Waste Liquid CA223 Gal. (��,, C Tl STATE ZIP CO. CITY STATE ZIP CO. PO # Gal. Wash Out Each HONE NO. Day PHONE NO. PROFILE NO.CU' OMER EPA ID NO. Z,6:� 3xq — 1,41`4t4 Hrs. 7 Fuel Surcharge Z.6-4 PRODUCT NVASTE MANIFEST CODE NUMBER QUANTITY UNITS PRICE AMOUNT Used oil, Non-RCRA Hazardous Lubricating CA22 �67j, Gal. Waste, Liquid Industrial CA221 Gal. Used Aulomotive Antifreeze, N- RCRA Hazardous Waste Liquid CA 134 G31. RQ Waste Cmnbustible Liquid, N-O.S_ NA 1993 in (Oil c 1—mated seal, haloeea) CA221 F001/1'002 Gal. Oil & Water, Non-RCRA Hazardous Waste Liquid CA223 Gal. Non Hazardous Water Gal. Waste Solids and Sludges Gal. Wash Out Each Pressure Washer/Steam Cleaner Day Transportation Hrs. Fuel Surcharge % ,Iycol Bulk 50/ /Specify Product Gal. ilycol Bulk onc./Specify Prrodu__ct�� Gal. TEST: Clor D Tech 400t�ppm Ej Clor D Tech 1000 Pass E] Fail Retain Sample # Required Total Charges Field Service Work Description: Other: Other: 7EV Z Consolidated Manifest rgreenOil, Inc. Evergreen Oil, Inc. - Davis Evergreen Oil, Inc. - Fresno 880 Smith Ave. Road 30B 4139 N. Valentine Newark, CA 94560 Davis, CA 95616 Fresno, CA 93722 CAD980887418 CAD982446874 CAD982446882 ❑Evergreen Env. Svc ❑ E%agreenOil, Inc. - Santa Alaria❑ 16604 S. San Pe 745 A West Betteravia Carson, CA 90 6 Santa Maria. CA 93454 CAD981696 -0 CAD982446858 DRIVER ECKLIST ❑ Time In Time Out _ ❑ Tank/Drum Properly Labeled ❑ Accumulation Start Date Marked ❑ House Keeping - Tank/Drum Clean A ❑ Other Services Checked: ❑ Oil, ❑ Filters/Drums, ❑ Antifreeze ❑ Called in other services needed ❑ Oil, ❑ Filters/Drums. ❑ Antifreeze 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 determined by Marine ❑ Agricultural ❑ 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 side of this form. IMPORTANT NOTICE REGARDING THE 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 —)ly with the more stringent requirements applicable to hazardous waste management facilities. California facilities that handle or process used quired to meet those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements. ii elude more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for L_u e nd accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards and t these more stringent requirements. This notification is for information purposes only. ,>< Signature Print Name ute # Date e erator's Sicynature Print Name Date