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WORK ORDER/SERVICE
<br />x EA7,- gl een EJjN7jiWiental Sen7jces
<br />,IrclirrNrd ru rhe prr�trrti,,n r,l rhe c'nrirrnntrnt
<br />To schedule a pickup, call
<br />800-596-9455
<br />6880 Smith Ave.. Newark, CA EPA# CAD982413262
<br />16540 S. San Pedro St., Carson. CA EPA# CAD982413262
<br />GENERA"COR/JOB LOCATION
<br />Senct panttcnt to:
<br />AGREENIENT
<br />t t
<br />0 h
<br />Sales Order #
<br />E\crL,rcen Oil. Inc.
<br />P.O. 130? .10517
<br />Los Am-- ele<. CA 900',0-O) 17 Date:
<br />BELLING INFORMATION
<br />NANIE
<br />NANIE
<br />C.ksH ❑ clfl:Ch ❑
<br />ADDRESS
<br />WDRESS
<br />CUS'CONIER CODE': NO.
<br />(TIN STATE LIP
<br />Co.
<br />Cefl'
<br />STATE 7_I1)
<br />CO.
<br />PO #
<br />PHONE NO.
<br />1 1
<br />PHONE NO.
<br />1 )
<br />PROFILE, No.
<br />CLSTOME:R I;PA 1D NO.
<br />PRODUCT
<br />11':1S'I'I?
<br />CODE
<br />N1,INIFES'h
<br />NUMBER
<br />(1U:lN7lTl" UNITS PRICE
<br />1NIOLINT
<br />L7,cd oil. Non-RCR:A Hai;irdou, LuhricatingI
<br />CA_"1
<br />Gal.
<br />\\;tstc. Liquid Indil'imil
<br />GVi'_I
<br />Gal.
<br />CAI 3-I
<br />Gal.
<br />dnOh i,
<br />nn ntuit'
<br />Gal.
<br />Oil
<br />Oil k W;ucr. Non-RCRA Ho/:Irdous Willie Liquid
<br />C;A221
<br />Gal.
<br />\\ rite Solids and Skid'-,cs
<br />Gal.
<br />\V';Ish Out
<br />L-ach
<br />Drained U,ed Oil Filtcrs
<br />Drum
<br />Von-RCR,A Hazardou, \A'a,c Solids toil\ debris)
<br />CA_"_;
<br />Drum
<br />F:mpl Drum,
<br />Drum
<br />Tran,hoiumon
<br />I
<br />I -II,s.
<br />Von Hazardlnls AVatC
<br />Gal.
<br />Ghcol Bulk 511/50
<br />Gal.
<br />GIvcoI Bulk Conc.
<br />Gal.
<br />TEST:❑ Clot- D Tech 4000 ppm ❑ Clor D Tech 100(1❑Pass ❑ Fail ❑
<br />H,do�,,en Detector/Rime Tell ❑ Pa„
<br />❑ Fail
<br />Field Service Work Dcsrriptiun:
<br />Tttlatl Charr�es
<br />Other:
<br />Other:
<br />\':ovum Sen ire, Time
<br />Out of lard On Site Off Site
<br />011 Load Slaw
<br />011 Load End Rciurn to Yard
<br />nm
<br />❑ Consolidated Manifest
<br />❑Evci-leen Oil. Inc. ❑ Ecerereen Enc. Sic.1:1EvcjLicen E. S%c. 1:1:US Fiher ❑
<br />6StiN Smith .A%c. Road 300 4139 N. Valentine 15131 Clark .Ave.
<br />Ncv mL CA 94500 Dais. CA 95616 Fresno. CA 937'__1 Indo>t v. CA 91745
<br />C.ADQWM7418 CAD982446S74 CA D"'24468.82 C:AD060097432
<br />Gcer,-,ren Enc. See. ❑ EvcrLrecn L=nv..Svr. ❑CFR ❑CFR ❑ Greenleal Enc. Sri,
<br />16604 S. San Pedro 745A \Vrest 13ettcnnia 944 E. Slau,on Ave. 3110 \V'e,tern 3474 Town Circle
<br />Cl,mi. CA 90746 Santa N1,Iria. CA 93-'.54 t.o, .An2cic,. GV 911(11 I Union City, CA 94567 Valley Spring,. CA 95352
<br />C:AD9,M696420 C.AD98244W;8 CAI -0001 10021 CAL0000l )1507 C. -A1-6002 14 4 11
<br />� �y Generator octtllies 111;11 I Ila, C,I 11111 #ted o pt ogmill In IadLKC ilh! Salome or
<br />SOtIhCC: ®1 COII�C11011 Stat1011 �IOV'( rHI11ZIlt yu [11111v l to iuty d the hanudom c to the de-ice ducillimed by
<br />Marine Lj AgriCLlltilral j IIICILIStrlal ^cnuctlor m he Cunonu(2ally piacn(2tLlC.
<br />I hereby certih that I have read and hale the authority to
<br />bind the above listed generator to the terms on the reverse
<br />Retain sample # side of this form. -
<br />IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL.
<br />Per California Health and Safet,\ Code Section 25250.9. Ecci Lreen hercb\ adv iser Custonler th:u Customer's shipment o1 tiled t)il nut) be
<br />uansportcd to a lhcilit}' that is required to Comply yyitlh federal reIulations applicable to nlanasement of used oil_ but that is r.-ot required to
<br />'pl\ v0th the more strinLent requirements appliC lhIC to hazau'Jous V,&4C mann«ement f.uilitic,,. California lacilities lhi it handle or prol used
<br />rC leyliired to s meet thole more >tl-in�Cent requirements. and Some out-of-,taic lacilitics (hat prot-cs„< u.,ed oil also 1�1cct ihtt>c rcquircnlent,.
<br />c iu�:ude marc ,ui -I C lc,tl: detection 1i�; hrCsenti;m rcquiremcl i;. cn��tnecti �� ,Crtificatic tr, of tun1; ill[CL'rit— Jird ;_n_:,icKd a„�uan�Cs 1nr
<br />Closure and ❑ c:idCntal releasCs. It i, liMfUl to send used oil to out-r,f-,elle flteilitics that conlpl� only ycith fccdcral used CJI m.tna1-1cme1)t staodau'ds
<br />arn_d not Ihese more ,,t inLcllt PcyuiremCnts. This notificatio,i is for inliirm<nion purposCs only.
<br />
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