COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

WORK ORDS 3)ERVICE AGREEMENT �Evergreen Environmental Services No 680129 V dedicated to the protection of the enn•invnurent To schedule a pickup, call Send payment to: Sales Order # 800-972-5284 E,•ergreen Oil, Inc. 6880 Smi1h Ace., Newark. CA CPA# CAD982413262 Dept. LA 23234 �v �i 5 16540S. San Pedro St.. Carson. CA FPA# CAD982413262 Pasadena, CA 91185-3234 Date' 1 GENE, RATOR/JOB LOCATION BILLING INFORA•IATION >0 tEI NADIE,, CASH p CHECK ❑ ` t� CA226 LSE' ADDRFSS .L ADDRESS CUSTOMER CODE NO. $ lice Gal. U.ed Auiomotise Antifteeee, Ikon-RCRA ttvudous Wast? Li"id CITY STATE ZIP CO. CITY STATE ZIP CO. PO # PHONE NV. PHONE NO. OFILE NO. PR GUSTO\MER EPA ID NO. �f = ( ) Cj-t ' ' PRODUCT WASTE CODE NIANIFEST QUANTITY UNITS PRICE AMOUNT NUMBER Used oil, Non-RCRA Hazardous Lubricating CA226 LSE' Gal. Waste. Liquid industrial CA221 Gal. U.ed Auiomotise Antifteeee, Ikon-RCRA ttvudous Wast? Li"id CA 13 Gal. RQ wite Comtvulible Liquid, N-0 -11A 1993 in (Oil conuminm W %0h h CA221 F001/M2 Gal. Oil & Water, Non-RCRA Hazardous Waste Liquid CA223 Gal. Non Hazardous Water Gal. Waste Solids and Sludges Gal. Yash Out Each Pressure Washer/Steam Cleaner Day Transportation Hrs. Fuel Surcharge % Glycol Bulk 50/ /Specify Product Gal. Glycol Bulk onc./Specify Product Gal. 'PEST: 2fclor D Tech 40002-teippin ❑ Clor D Tech 1000 Pass ❑ Fail Retain sample# Required I Total Charges Field Service Work Description: Other: Other. TSD 2r Consolidated Manifest DRIVER Evergreen Oil, hie. Ecergatn Oil, Inc.- DavisEvergreen Oil; Inc. - Fresno ElTime In Time Out 6880 Smith Ave. El Road 308 4139 N. Valentine Newark, CA 94560 Davis. CA 95616 Fresno, CA 93722 D Tisnk/Drtiiii Properly Labeled CAD980887418 CAD982446874 - CAD982446882 G Accumulation Start Date Marked - Evergreen irkedEvergreen Env. Svc. Ewnp enMInc.-Sc+>*11Uia� n Hoose Keeping - Tank/Drum Clean 16604 S. San Pedro El 745 A West Beiterivia ❑ Other Sen,ices Checked: G Oil, ❑ Filter.,/Dnums, D Antifreeze Carson, CA 90746 Santa Maria, CA 93454 CAD98169fi4� CAD982446858 ❑ Called in other services needed ❑ Oil, ❑ Filtcrs/Drums, ❑ Antifreeze Generator certifies that it has establishedat program to reduce the volume or Source: CdCofiectioti Station ❑ Goveniment quantity & toxicity of the hazardous waste to the degree determined by ❑ Maine ❑ Agt7cultural ❑ llldustllal generator to be economically practicable. I hereby ccrtil), that I have read and have the authority to bind the above listed henerntor to the terms on the reverse side of this form, INIPORTANT NOTICE REGARDING'I'HE DISPOSITION OF YOUR OIL, Per Californin Health and Safety Code Section 25250.9, Evergreen hereby advises customer that customer's shipment of used ail may be transported to a facility that is required to comply with federal regulations applicable to tnanagenicnl of used oil, but that is not required to comply with the more stringent requirements applicuble to hazardous waste management facilities. California facilities that handle or process used oil are required to meet those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements. These include more stringent leak detection and prevention requirements, engineering certifications of tattle integrity, and financial assurances for close landaccidctital releases. It is lawful to send used oil to out-of-state facilities That comply only with federal used oil management standards and i these more stringent requirements. This notification is for information purposes only. �f - tver Signature Print Name Route # Dake Generator' gnat a Print Name Date White Copy=Customer Copy - Pink & Yellow Copy=Office Use - Green Copy- ach to mani est - Goiden Copy=Driver Copy