COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

WORK ORDER/SERVICE AGREEMENT Evergreen Envii mental Services N° 636206 dedicated to the protection of the environment To schedule a pickup, call Send payment to: Sales Order# A; 800-596-9455 Evergreen Oil,Inc. 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: GENERATOR/JOB LOCATION BILLING INFORMATION NA E v � NAM /t CASH� CHECK # D ESS ADDRESS' CUSTOMER ODE NO.- STAPE ZIP . CITY STATE ZIP CO. PO# PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT CODE NUMBER Used oil,Non-RCRA Hazardous Lubricating CA2 Gal. Waste,Liquid Industrial CA221 Gal. Used Automotive Antifreeze,Non-RCRA Hazardous CA 134 waste Li aid Gal. RQ Waste Combustible Liq inated with uid,N.O.S.NA CA221 Gal. 19nt 93 In Oil coamhalogens) F001/F002 Oil&Water,Non-RCRA Hazardous Waste Liquid CA223 Gal. Non Hazardous Water Gal. Waste Solids and Sludges Gal. Wash Out Each Pressure Washer/Steam Cleaner Day Transportation Hrs. Fuel Surcharge % Glycol Bulk 50/ /Specify Product Gal. Glycol Bulk onc./Specify Product Gal. TEST: Clor D Tech 400t1�Lppm ❑Clor D Tech 1000 Pass ❑Fail Retain sample# Total Charges Required Field Service Work Description: Other: Other: TS Consolidated Manifest DRIVER CHE Evergreen Oil,Inc. ❑ Evergreen Oil,Inc.-Davis❑ Evergreen Oil,Inc.-Fresno ❑ Time In Time Out 6880 Smith Ave. Road 30B 4139 N.Valentine Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 El Tank/Drum Properly Labeled CAD980887418 CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked ❑ Evergreen Env.Svc. ❑ E),uV=(l,Inc.-SantaMana❑ ❑ House Keeping-Tank/Drum Clean 16604 S.San Pedr 745 A West Betteravia ❑ Other Services Checked: ❑ Oil, ❑ Filters/Drums, ❑Antifreeze Carson,CA 907 Santa Maria,CA 93454 CAD9816964 CAD982446858 10 Called in other services needed ❑Oil, ❑ Filters/Drums,❑Antifreeze Generator certifies that it has established a program to reduce the volume or Source: Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by ❑Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. I hereby certify that I have read and have the authority to bind the above listed generator to the terms on the reverse side of this form. IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. Per California Health and Safety Code Section 25250.9,Evergreen hereby advises customer that customer's shipment of used oil may be transported to a facility that is required to comply with federal regulations applicable to management of used oil,but that is not required to comply with the more stringent requirements applicable to hazardous waste management facilities.California facilities that handle or process used oil ar quired to meet those more stringent requirements,and some out-of-state facilities that process used oil also meet those requirements. Thes in lude more stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for cicis re nd accidental releases.It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards an not hese more stringent requirements.This notification is for information purposes o y.l //-,Po A D ver Signature not Name Route# Date Generator's Signature Print Name Date Whita r.nnv—r-etnmar r.nnv-Pink R Vallrrnnr r---r)ffina I Ica-(,roan r`nrni—AMarh fn—if—+-r]nlrfon inn„_nri„�.r`nnv