Laserfiche WebLink
WORK ORDASERVICE AGREEMENT <br /> Evergreen FAwironmental Services N° 687370 <br /> dedicated to the protection of rhe environment <br /> To schedule a pickup,call Send payment to: <br /> r� r� <br /> Sales Order# <br /> 800-972-5284 Evergreen Oil,Inc, <br /> 6880 Smith Ave„Newark,CA IRPAN CAD982413262 Dept.LA 23234 <br /> 16540 S.San Ptulro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: <br /> GENERATOR/JOB LOCA'T'ION BILLING INFORMATION <br /> NAN19 NAME CASH Q CHECK <br /> MDRESS ADDRESS CUSTOMER CODE NO. <br /> STA'T'E zIP CO- CITY STATE ZIP CO. PO# <br /> PH NE NO. PRONE NO. PROFILE NO. CUSTOMER EPA,ID NO, <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Nen-RCRA Hazardous Lubricating CA22 Gal, <br /> Waste,Liquid Industrial CA22I Gal. <br /> U¢W Aumnmuv¢AMI&YAm Nen•RCRA Hamdwe CA l 34 Gal, <br /> Wats Li ld <br /> RQ WYela Combuetibl¢Llq.a'd ccA�2� <br /> 149)111 G1 com¢minAt wl FUOIIT 4 Gal. <br /> Oil&Water,Non-RCRA Hazardous Waate Liquid CA223 Gal, <br /> Non Hazardous Water Gal, - <br /> Waste Solids and Sludges Gal. (� J' <br /> Wash Out Each <br /> Pressure Washer/Steam Cleaner Day <br /> W 1 TU <br /> Transportation Hrs. <br /> Fuel Surcharge % <br /> Glycol Bulk 50/5 Specify Product Gal, <br /> Glycol Bulk c./Specify Product Gal. <br /> TSST ZClor D Tech 4000 ppm C]Clor D Tech 1000 Pass C]Fail <br /> Refain sample# Total Ch s <br /> Required <br /> Field Service Work Description. <br /> Other: <br /> Other: <br /> TSDF Consolidated Manifest DRIVER C IST <br /> �Fvergreen Oil,Inc. ❑ Evetg�een OII,Inc.•Davis Evergreen Oil,Inc.-Fresno ❑ ISmc Ir>_ Time Out <br /> 6880 Smith Ave. Road OB ❑4139 N.Valentine ❑ Tank/Drum Properly Labeled <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 y <br /> CAD98OM7418 CAD982446874 CAD992446982 ❑ Accumulation Start Date Marked <br /> L] Evergreen Env.Svc. lOil Ltc-5antaMtada❑ El House Keeping-Tank/Drum Clean <br /> 16604 S.Sen Pedro ?4A West Betttravia ❑ Othcr Services Checked: ❑Oil, ❑ Filters/Drums, ❑Antifreeze <br /> Carson,CA Santa Maria,CA 93454 <br /> CAD981696420 CAD982446856 ❑Called in other services needed Oil, n Fllters/Drums, Antifreeze <br /> 420 <br /> Generator ceriffies that it has established a program to reduce the volume or <br /> Source: EfCollection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑Marine ❑ Agricultural Q Industrial generator to be economically practicable. <br /> I hereby certify that I have read and haye the authority to <br /> bind the above 14Ated r to the terms on the reverM <br /> Fide 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 oil may be <br /> transported to a facility that is required 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 more stringent ra uirements,and some out-of-state facilities that process used oil also meet those requirements. <br /> These include morn stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> closure and accidental releases_It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> andLe these more stringent requirements,This notification is for information purposes only, <br /> jet", �Dw 11:40-13 / m 1111611, <br /> river Signature Print Name Route# Date Generator's Signature Print Name Date <br /> ZZ01800'd \A....*.r•,..,_r,.. ,r ,,6VW,0 V n .._nu l - r-- A.- .-----. 8ti- - S LOZl9010 L <br />