Laserfiche WebLink
A WORK ORDER/SERVICE AGREEMENT <br />AEvergreen Environmental Services N° 3 9 4 7 3 2 <br />dedicated to the protection of the environment <br />To schedule a pickup, call Send payment to: Sales Order # <br />800-596-9455 Evergreen Oil, Inc. <br />6WO Smith Ave., Newark, CA EPA* CA0982413262 P.O. BOX 30517 �, � y � 7 <br />16540 S. San Pedro St., Carson, CA EPA# CAD962413262 LOS Angeles, CA 90030-0517 Date: <br />—f <br />LOCATION BILLING INFORMATION <br />PRODUCT <br />WASTE <br />CODE <br />MANIFEST QUANTITY UNI'T'S PRICE AMOUNT <br />NUMBER <br />Used oil, Non-RCRA Hazardous Lubricating <br />Waste, Liquid Industrial <br />NAME <br />LIM2X&J)vOld- <br />Gal. <br />CASH CHECK ❑ <br />CA 134 <br />Gal. <br />ROW a,. 111. NA <br />49 oil waammued wim m <br />t <br />Gal. <br />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />CA221 <br />DRESS <br />Waste Solids and.Sludges <br />t <br />ADDRESS <br />Wash Out <br />CUSTOMER CODE NO, <br />Each <br />at tit► <br />Gar <br />Drum <br />Non-RCRA Hazardous Waste Solids (oily detnis) <br />PNl <br />CI <br />STATE <br />ZIP CO. <br />CITY <br />STA'L'E ZIP CO. <br />PO # <br />firs. <br />Non Hazardous Water <br />Gal. <br />Glycol Bulk 50150 <br />PHONE NO. <br />Glycol B Cone.-�-� <br />PHONE NO, <br />TEST: aur D Tech Out Zft_ppm C] C'lor D 'Tech IOOU C6 <br />PROFILE NO. <br />CUSTOMER FPA m NO, <br />r -r <br />- <br />Other: <br />) <br />Other:. <br />vacuufft Services Time <br />Out Yard Oil Site Off Site <br />r <br />PRODUCT <br />WASTE <br />CODE <br />MANIFEST QUANTITY UNI'T'S PRICE AMOUNT <br />NUMBER <br />Used oil, Non-RCRA Hazardous Lubricating <br />Waste, Liquid Industrial <br />CA22tt <br />CA221 <br />LIM2X&J)vOld- <br />Gal. <br />UW Autamadl AndaceK Non-RCRA HAYMdAM <br />CA 134 <br />Gal. <br />ROW a,. 111. NA <br />49 oil waammued wim m <br />t <br />Gal. <br />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />CA221 <br />Gal. <br />Waste Solids and.Sludges <br />Gal. <br />Wash Out <br />Each <br />Drained vLd Oil Filters <br />Drum <br />Non-RCRA Hazardous Waste Solids (oily detnis) <br />CA223 <br />Drum <br />Empty Drums <br />Drum <br />Trannporation <br />firs. <br />Non Hazardous Water <br />Gal. <br />Glycol Bulk 50150 <br />Gal. <br />Glycol B Cone.-�-� <br />Gal. <br />TEST: aur D Tech Out Zft_ppm C] C'lor D 'Tech IOOU C6 <br />Pass (] Fail ❑ Halogen Detector/Flarne Test Xpass ❑ Fail <br />Field Service Work Description: <br />Total Charges <br />Other: <br />Other:. <br />vacuufft Services Time <br />Out Yard Oil Site Off Site <br />Off Load Start 4 Off Load End Return t and <br />116880 <br />F Consolidated Manifest <br />vergreen Oil, Inc. Evergeen Env. Svc. Evergreen Env. Svc. ( 7 A1S Filter <br />Smith Ave. ❑ Road 30B 4139 N. Valentine iui 15131 Clark Ave. <br />Ngwurk, CA 94560 Davis, CA 95616 Fresno, CA 93722 Industry, CA 91745 <br />CAD980887418 CAD982446874 CAD982446882 CA0000097432 <br />❑ Evergreen YL15' <br />. ❑ Flvergrein Env, Svc. ❑ CFR Q CFR I—I Ci=nteaf Rnv. Svc. <br />16604 S. S7 745 A West Ratcravia 944 F.,. Slauson Ave. 33210 Western LJ 3474 Toynn Circle <br />Carson, CA Santa Maria,CA 93454 Los Anggeles, CA 90011 Union City, CA 94587 Valleyy ti rings, CA 95352 <br />CAD982446858 C.AL0fd01IM21. CAL000091507 CAL000214411 <br />Genrrawr certifies that it has established a program to reduce, the volume or <br />5aurce: Collection Station 0 Government quantity & toxicity of the hazardous waste to the degree determined by <br />❑ Marine ] A rieultural 0 Industrial generator to he economically practicable. <br />I hereby certify that I have read and have the authod y to <br />bind the above listed generator to the terms on the reverse <br />Retain sample # �f side of this form. <br />IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br />Per California Health and Safety Code Section 25250.9, Evergreen hereby advises customer that customer's shipment of used ail may be <br />transported to a facility that is required to comply with federal regulations applicable to management of used ail, but that is nod required to <br />comply with the more stringent requirements applicable to hazardous waste management facilities, California facilities that handle or process used <br />Z are required to meet those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements. <br />Thesc include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for <br />cl rc and accidental relcases. It is lawful to scud used oil to out-of-state facilities that comply only with federal used oil management standards <br />a mt these more stringcnt acquirements. This noli(ieation is for infon»atiotl purposes only. <br />L Z_—DU <br />