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<br />I
<br />WORK OP"ER/SERVICE AGREEMENT
<br />OEvergree &t . aronmental Services
<br />dedie ted to the protection of the envirornment
<br />To schedule a pickup, call ttcl p�)%me itt to:
<br />', 800-596-9455 Evergreen Oil, inc.
<br />6880 Smith Ave., Newark, CA EPA# CAD982413262 P.O. BOX 30517
<br />16540 S. San Pedro St., Carso , CA EPA# CAD982413262 Los Angeles, CA 90030-0517
<br />GENERATOR/JOB LO ATION BILLING INF-OR41ATION
<br />Sales Ord/4
<br />Dat/? 0'1�
<br />16
<br />PAF
<br />l 11Gl GV] IGT I.f! lllnl • llar.,..., G Ma. Hin llavG 1- a-101/lY UP
<br />bind the above listed generator to the terms on the reverse
<br />Retain sample # side of this form.
<br />IM ORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL.
<br />Per California Health and Safet Code Section 25250.9, Evergreen hereby advises customer that customer's shipment of used oil may he
<br />transported to a facility that is req 6red to comply with federal regulations applicable to management of used oil. but that is not required to
<br />comply with the more stringent requirements applicable to hazardous waste management facilities. California facilities that handle or process used
<br />oil are required to meet those mort stringent requirements, and some out-of-state facilities that process used oil also meet those requirements.
<br />These include more stringent leak letection and prevention requirements, engineering c ifications of tank integrity. and financial assurances for
<br />closure and accidental releases. it s lawful to send used oil to out-of-state facilities ply only with federal used it management standards
<br />and not these more stringent requi ements. 711is notification is for information purp ses nl
<br />n,-;. ,,, :..ra D,.,,,« nt, t. D 44 r) TIT".— n «
<br />NAME
<br />CASH ❑ CHECK ❑
<br />#
<br />�J r
<br />�z }CO.
<br />ADDRESSS
<br />L�fvTER �j 'PQU.
<br />S k TF�v��" P
<br />CITY
<br />STATE ZIP CO. PO #�
<br />P - 1`tfJa
<br />PHONE NO.
<br />PROFILE NO.
<br />PRODUCT
<br />WASTE MANIFEST
<br />CODE NUMBER
<br />QUANTITY UNITS PRICE AMOUNT
<br />Used oil, Non-RCRA Hazardous
<br />Lubricating CA221
<br />Gal.
<br />W ste. Li uid
<br />industrial CA221
<br />Gal.
<br />d °i /
<br />Gal.
<br />RQ waste .nmbus a
<br />1993 111 loll c al c
<br />*A134
<br />Oil & Water, Non-RCRA Haza e s Was 1 uid _
<br />Gal.
<br />Waste Solids and Sludges
<br />Gal.
<br />ZZ
<br />Drained Used Oil Pipers
<br />Drum
<br />Non-RCRA Hazardous Waste Solis (oily debris) CA223
<br />Drum
<br />Empty Drums
<br />Drum
<br />Transportation
<br />Hrs.
<br />jr
<br />^„
<br />Glycol Bulk 5(A0
<br />Gal.
<br />Glycol Bulk Conc.
<br />Gal.
<br />TEST: ❑ Clor D Tech 4000
<br />ppm ❑ Clor D Tech 1000 ❑ Pass ❑ Fail ❑ Halogen Detector/Flame Test ❑ Pass ❑ Fail
<br />Field Service Work Description:
<br />Other:
<br />Other:
<br />Vacuum Services Time
<br />Out of Yard On Site
<br />Off Site Off Load Start Oft Load End Return to Yard
<br />TSDF
<br />Evcggrecn oil, inc. ❑ '
<br />6880 Smith Ave. R
<br />Newark, CA 94560 D
<br />CAD980887418 C4,D982446974
<br />❑Evergreen Env. Svc. ❑ E
<br />16604 S. San Pedro 7
<br />Carson. CA 90746 S
<br />CAD981696420 C
<br />❑ Consolidated
<br />iergrcen Env. Svc.ElEvergreen Env. Svc.
<br />ad 30B 4139 N. Valentine
<br />avis. CA 95616 Fresno, CA 93722
<br />CAD982446882
<br />•ergreen Env. Svc. ❑ CFR
<br />5 A West Betteravia 944 F. Siauson Ave.
<br />nta Maria. CA 93454 Los Angeles, CA 9(X)11
<br />kD982446858 CAI,000110021
<br />tation ❑Government
<br />Agricultural ❑ Industrial
<br />Manifest
<br />❑ AIS Filter ❑
<br />15131 Clark Ave.
<br />industry. CA 91745
<br />CADOW097432
<br />❑ CFR ❑ Greenleal' Fnv. Svc.
<br />33210 Western 3474 Toyon Circle
<br />Union City. CA 94587 Valley Springs. CA 95352
<br />CAL00(X)91507 CAL0002I"II
<br />Generator certifies that it has established a program to reduce the volume of
<br />quantity & toxicity of the hazardous waste to the degree determined by
<br />generator to be economically practicable.
<br />7 1. .,...,1,., .,.,..«1C.. «1,.,« 1 16 .. .,A .,...1 {....,..
<br />Source: ❑ Collection
<br />❑ Marine ❑
<br />PAF
<br />l 11Gl GV] IGT I.f! lllnl • llar.,..., G Ma. Hin llavG 1- a-101/lY UP
<br />bind the above listed generator to the terms on the reverse
<br />Retain sample # side of this form.
<br />IM ORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL.
<br />Per California Health and Safet Code Section 25250.9, Evergreen hereby advises customer that customer's shipment of used oil may he
<br />transported to a facility that is req 6red to comply with federal regulations applicable to management of used oil. but that is not required to
<br />comply with the more stringent requirements applicable to hazardous waste management facilities. California facilities that handle or process used
<br />oil are required to meet those mort stringent requirements, and some out-of-state facilities that process used oil also meet those requirements.
<br />These include more stringent leak letection and prevention requirements, engineering c ifications of tank integrity. and financial assurances for
<br />closure and accidental releases. it s lawful to send used oil to out-of-state facilities ply only with federal used it management standards
<br />and not these more stringent requi ements. 711is notification is for information purp ses nl
<br />n,-;. ,,, :..ra D,.,,,« nt, t. D 44 r) TIT".— n «
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