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<br /> dedicated to the pt n of the enuut»titsent 'Y
<br /> Ta schedule::a picktap;Call ' Send paymentto} - Sales Order
<br /> 60pw596,'948 >;v�r� ert otl >ne
<br /> 6884 S_ith Ave:,Ttewark,CA EPA.#CA15982473262 Dopt,.LA 232341.
<br /> 16'540 S.San Pe&6 Sf.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185 X234 Date "°
<br /> QENERATOR/JOB"LOCATION BILLING I RMATION "
<br /> 141E - NAME - SASH.[]CHECK p
<br /> ADDRESS ADDRESS0 vox ST" ER Ct)1?E NO
<br /> SVkTE ZIP CO. CITY STATE ZIP CO. PO# a
<br /> PH EIV® PHONE NO. __JPROFILE IVU. CUSTOMER EPA ID IYiO
<br /> V{iAST9S '%)=.T,� PRODUCT QUANTITY UNITS PRICE. AMOUNT..
<br /> CODE TVUINRER
<br /> Used oil,lVon-RCRA Hazardous Lubricating` CA221� � � Gal. �
<br /> Waste,Liquid Industrial CA221 Gal.
<br /> .. Used�Amtatwte6e AnGftceze'Non-RCRAHaerdato CAl`. - C"ral.. +:-•.• .
<br /> WastaL aid
<br /> CA22r
<br /> -77777
<br /> Ro.WmteCutnbnstitileLiquW.N:o9 NA '. �i ..
<br /> I
<br /> 3dlf i contaminaledw[ffiHalo e,re F0a17F002
<br /> Oil.&,.Water;Hon-RCRAA Hizirdous Waste Liquid CA223 Gal..
<br /> Non Hazardous.WgOr. Gal..
<br /> Waste Solids and Sludges ' GaL:• r....
<br /> Wash Out, Each..,.- i
<br /> Pressure Washer/Steam Gleaner" Day
<br /> Transportation His.
<br /> Fuel suicharg
<br /> Glycol Bulk 5 OlS-pecify Product Gal.
<br /> Glycol Bul ®nc,/Specify Product Gal.
<br /> TPS 1 Cior IYTecit4000 ppm.E]Clor D Tech'1000®Pass El Fail-®-Pass ❑.Fait "r
<br /> 2etalln sBlxiple# Total Char es
<br /> Required
<br /> Field Service Work Description:
<br /> Other:
<br /> Other:
<br /> TWO Consolidated Manifest RIVER CHECKLIST
<br /> Evergreen Oil,Inc. Evergreen Oil,Inc,-Davis Evergreen Oil,[nc.-Fresno 17 Time Ilt' a Out
<br /> 6880 SmN AVe. ❑ Road 30B ❑4139.N.Valentine
<br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA.93722 -Tank/Drum Properly Labe d.". a
<br /> CAD98088y4t8 CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked
<br /> ❑ Evergreen Lhv..St�1,Ltc Salaalviaia ❑ House Keeping-Tank/D>tim Clean
<br /> 16604 S San F. FO. ❑ 74 A West aetteravia ❑ q Other:Services.Checked: ❑Oil, ❑ Filters/Drums,.p Aritifree.ze
<br /> Carson,CA." 6 Santa Maria,CA 93454 ❑ Called in other.services needed Oil,. Eilters/Drums,. .Antifreeze,.
<br /> CAD981-6 0 CAD982446859
<br /> Generator.certifies that it-has established a programto•redVice the volume or
<br /> Source: Collection Station ®Government quantity&_toxicity of ttte 48zardoos waste to the degree detertntned;by
<br /> i mine" O.Agi1CUItU d� 'O �CIf�US>71Si generator to be economccally:practi stile
<br /> I`hotft car r!tha#.1:have f@ and:have the authorlty.to .
<br /> hind,the above ted geiieretor'to:the ftrinisoh t treverse.
<br /> s o this form,
<br /> IMPORTANT NOTICE RE.GARDING.THE DISPOSITION OF YOUR OIL.
<br /> Per California Health and Safety Code Section 2525t1,9,Evergreen her6by advises customer that customer's shiprnenl 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 isnot required to •
<br /> comply with the more stringent requirements applicable to hazardous Waste management.facilities.California facilities,that handle or.process used
<br /> bit are quired:to meet those more stringent requirements,and some out o£-state.facilities that process used oil-alwiineet those requirements.
<br /> These pelude more stringent leak detection and-prevention requirements,engineering certifications of tank.integrity,and financial assurances for
<br /> closurk and accidental releases.It is lawful to'send usedvil to,out-of-state facilities•thg o ply`only with federal used oil management standards
<br /> and n these more stringent req irements:This notification is for itifoirnaiian.pU-. s!es o y;.
<br /> Dr` erSignature rtttl Rotic # Date hner�ator'>;`Signature Print°Name -Date` `
<br />
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