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<br />WASTE
<br />CODE
<br />WORK ORDER/SERVICE AGREEMENT
<br />QUANT111Y LI\ITS PRICE
<br />Vel i'eeil 11V1 lmental
<br />Services
<br />y t
<br />1p
<br />dediruted to the puznertioll of the em ironnrent
<br />�#
<br />Wa,te. Liquid InLLMI_1:11
<br />CA) -
<br />A7_CAI
<br />To schedule a pickup, call
<br />15131 Clark Avc.
<br />Sales Order Joo Z. 3 e ' 6
<br />DDRES'
<br />800-596-9455
<br />E, erereen oil. Inc.
<br />Gal.
<br />6880 Smith
<br />Ave., Newark, CA EPA# CAD982413262
<br />P.O. BOX 30517
<br />16540 S.
<br />San Pedro St., Carson, CA EPA# CAD982413262 Los
<br />An«eles. CA )0030-0517
<br />Date.
<br />GENERA7'ORM013
<br />LOCATION BILLING
<br />INFORMATION
<br />W\ NC SOIld, and Sludec,
<br />11Wlso%
<br />WASTE
<br />CODE
<br />NAME
<br />QUANT111Y LI\ITS PRICE
<br />❑ CHECK ❑
<br />AkA
<br />CA"
<br />�.
<br />Gal.
<br />�#
<br />Wa,te. Liquid InLLMI_1:11
<br />CA) -
<br />A7_CAI
<br />15131 Clark Avc.
<br />DDRES'
<br />CA 134
<br />ADDRESS
<br />Gal.
<br />CLiS" IER CODE,
<br />R(1 \Y.iac C�nnhu.fi blc LiyuiJ-SILS.S�
<br />HO„���.,�„��:�I�a „ 11, i�.a„.,��,.,
<br />C:A2'1
<br />nloitrun,
<br />Gal.
<br />C'AD9S'446574
<br />"TN' .. STAT : ZIP
<br />CO.
<br />CETT"
<br />STATE ZIP CO.
<br />PO If
<br />W\ NC SOIld, and Sludec,
<br />❑tvu_,recn
<br />Enr. Scc.
<br />Gal.
<br />CFR❑
<br />PITONE NO.
<br />CiR
<br />PHONE NO,
<br />Each
<br />PROFILE, NO.
<br />CUSTOMER EPA ID NO.
<br />944 E. Slauwn .Ase.
<br />Drum
<br />3210 \1e,teln
<br />Nun-RCRA Fkt/mdous \\A1IC Solid, luils dehri,l
<br />CA" 3
<br />PRODUCT
<br />WASTE
<br />CODE
<br />MANIFEST
<br />NUMBER
<br />QUANT111Y LI\ITS PRICE
<br />AMOUNT
<br />LSerl uil, Non-RCR.A Hazaniou, Lubricating
<br />CA"
<br />�.
<br />Gal.
<br />>.
<br />Wa,te. Liquid InLLMI_1:11
<br />CA) -
<br />A7_CAI
<br />15131 Clark Avc.
<br />CA 134
<br />Gal.
<br />R(1 \Y.iac C�nnhu.fi blc LiyuiJ-SILS.S�
<br />HO„���.,�„��:�I�a „ 11, i�.a„.,��,.,
<br />C:A2'1
<br />nloitrun,
<br />Gal.
<br />C'AD9S'446574
<br />Oil cV \Vater. Nun-RCRA 11 t&LIdull, AVa,,te Liquid
<br />CA” I
<br />Gal.
<br />W\ NC SOIld, and Sludec,
<br />❑tvu_,recn
<br />Enr. Scc.
<br />Gal.
<br />CFR❑
<br />Wa,h Out
<br />CiR
<br />❑
<br />Each
<br />Diainrd UScel Oil Filte11
<br />944 E. Slauwn .Ase.
<br />Drum
<br />3210 \1e,teln
<br />Nun-RCRA Fkt/mdous \\A1IC Solid, luils dehri,l
<br />CA" 3
<br />Drum
<br />Enlpt. Drums
<br />Tr ml,portation
<br />I
<br />L'niun Cm'. CA 94557
<br />Drum
<br />Firs.
<br />V'allev S�11u1_;. CA 953 '
<br />Nun Hauudou, AV' ..r
<br />CADT'446S5R
<br />Gal.
<br />G11al1 Bulk X 50150
<br />C\L(i0o'14411
<br />Gal.
<br />GI<ro1 13t : Conc.
<br />Gellerahll'
<br />Gal.
<br />Ila,
<br />TEST: Clor D Tech 4000_416,ppm ❑ Clan
<br />D Tech I 0(1
<br />P;r;, ❑Fail ❑ Halogen Detertnr/Flame To,t ❑ Pa„ ❑ all
<br />Field Sen;Ce \Vork Dc,,cription:
<br />Ttil ai C�l2ll'�;c -.
<br />other:
<br />Other:
<br />Vacuum S (ices Time
<br />Out of and On Site 011 Site
<br />OI'ILuad
<br />S1:u1 Oil Load End Rciurn it) 1';ud
<br />T? r
<br />Evergreen Oil. 111C.(iAS(1 Smith A%C.
<br />Ncnark CA 94560
<br />CAD9S(15S7418
<br />❑Evergreen Em. Svc
<br />16604 S San Ped,
<br />Ctr,un C A 911' l
<br />C\D9SIh96
<br />Consolidated Manifest
<br />2
<br />1:1Ecer�_,reen
<br />Enc. Sic.
<br />❑
<br />E\cri_,reen Ens. Sic.
<br />11:US
<br />Filler
<br />❑
<br />12oatl 3013
<br />4139 N. Aa121lline
<br />15131 Clark Avc.
<br />/Dm is. CA L)5O1b
<br />Fre,no, CA 9371'
<br />Indu,irc. CA 9174
<br />C'AD9S'446574
<br />C\D982446SS'
<br />CAD000M7432
<br />❑tvu_,recn
<br />Enr. Scc.
<br />❑
<br />CFR❑
<br />CiR
<br />❑
<br />Greenleal Elv. Sic,
<br />74� A \\c 1 [3etter:nIa
<br />944 E. Slauwn .Ase.
<br />3210 \1e,teln
<br />3474 Tmon Ciicic
<br />SantLt AI u11 CA 93454
<br />Lo Aneelc,, CA 91.1()1
<br />I
<br />L'niun Cm'. CA 94557
<br />V'allev S�11u1_;. CA 953 '
<br />CADT'446S5R
<br />CALU(lllll(llL1
<br />C.AI_000091�07
<br />C\L(i0o'14411
<br />Gellerahll'
<br />CelliI C, Ihm It
<br />Ila,
<br />e"Iahll,hed .1 I1R'Lltjl IU redUCC the AlILIIIIC VI'
<br />1 SOLII-CC: iA C011CC6011 St;160I1 ❑ Government yu;uuitA ulvicits of the ha[:LIdnus wa,r to Ih� da��re detelinincd b�
<br />❑ Marine U AL rlCUlttlRl1 ❑ 111Clustrlal -operator to he eC, Iuicalh 1,I�ICticable.
<br />I heretic certify that I halve read and hate the authority to
<br />L.� bind the abo%e listed,generator to the terms on the reverse
<br />Retain sample # 1 side of this fortis.
<br />IMPORTANT NOTICEE REGARDING THE DISPOSI'T'ION Oh' YOUR OIL.
<br />Per California Health and Safet.N Code Section 25250.9, EyerLrcen herehv advi<e, Customer that CWt011WI >hipmCnt Ol'used Oil nr,OLe
<br />transported to Lt Ftcility that i; reyuirCd to Comps\ vpith federal regulations al)l liCable to ntuta_enlent Of used Cil. but that i, nut required tO
<br />nplr vlilh the more arineent rCyuirenlentti upplirahle to mLlnauenlent farilitie�. CLllifOrnia facilities that handle Cr prCees< u,cd
<br />re rr uirec( t0 meet those more ,trillLmlt requirements. Ltnrl >ome nut-ol-StLlte facilities th.tt prOCe„ U'cd oil :ILC sleet thO;e requitement,.
<br />,e in I c(e more ,irin«Cnt leak detection and prelenti0n reclt.irements. engiueuul� CcuiIiCL11i0ns of Coil: Inte�erit�,. ❑ntl financial Ln,tuanec< Iu,
<br />c1i>,ure n acCidental FJl Uses. It i, In ['111 to send used Oil to Out-of-sLIte tLlCilitie� that Cun1p1\ 0111V with fcderLd used oil mLlnLt�cnsent ,tandarJ�
<br />and nut 11 ,,C nwrr ,uiliernt reyuircment,. Thi, notification i, lot- inliwmmiOn limpo;e, o1111.
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