Laserfiche WebLink
10/0812010 10:04 f AX) P.0161045 <br />WORK ORDASERVICE AGREEMENT <br />Evergreen Environmental Services N° 510 516 <br />dedirared to the protection of the environment <br />To schedule a pickup, call Send payment to: Sales Order # <br />500-596-9455 Evergreen Oil, Inc. <br />SWO Smith Ave., Newark, CA ERAO CA0082413262 P.O. AOX 30517 <br />16540 a Son Pedro St., Carson, CA EPA# CAD9B2413262 Los Angeles, CA 90030-0517 Date: <br />CvVNERATORLTOR LOCA.TION BH,r.TNC TNV0*RMAT10N <br />PRODUCT <br />WASTE <br />CODE <br />MANRITST QUANTITY UNITS PRICE AMOUNT <br />NUMBER <br />Used oil, Non-RCRA Hazardous Lubricating <br />CA22 <br />416i.0 Gal. <br />Waste, Liquid Industrial <br />CA221 <br />R <br />t <br />CA 134 <br />r �rall <br />Rw-u cemb„e<ibts t tesla, xo s. xA <br />1943 iti CN cw,6rml d <br />A <br />I <br />Gal. <br />ii <br />CA221 <br />Gal. <br />NO,N, <br />1.0 6PHONE <br />, , <br />Each <br />A. - <br />PRODUCT <br />WASTE <br />CODE <br />MANRITST QUANTITY UNITS PRICE AMOUNT <br />NUMBER <br />Used oil, Non-RCRA Hazardous Lubricating <br />CA22 <br />416i.0 Gal. <br />Waste, Liquid Industrial <br />CA221 <br />Ciel. <br />Und Aw"OGve, APUROssa Nan-RCRA tipaardwa <br />Waft u� <br />CA 134 <br />EAI. <br />Rw-u cemb„e<ibts t tesla, xo s. xA <br />1943 iti CN cw,6rml d <br />A <br />I <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 Used Oil Filters <br />Drum <br />NoWiE;Z Hazardous Waste Solids (oily debris) <br />CA223 <br />Drutrt <br />Empty Drums <br />Drum <br />Transportation <br />14n, <br />Non Hazadous Wa <br />Gal. <br />Glycol Bulk 0150 <br />Glycol BulkZ Conc. <br />Gad. <br />Gal. <br />T'ES'T: Clor D Tech 400 m ❑ Cior D Tech 1000 <br />Pass Cj Fail ❑ Halogen DetectorMatne Test ❑ P Fail <br />Field Service Work Description: <br />Total Chal' eS <br />Othar <br />Other: <br />Vacuum S Time <br />Out of Y on Sit® Oft' Site <br />Off Remm Yard <br />V6L8V=0S,ilth0Ail�,1fi <br />Consolidated Manifest <br />c.1:1 Evergreen Env. Svc. Evergreen Farv. Svc. ❑ AIS Filter Rid 30B 4139 N. Valentine 15131 Clark Ave <br />Newark, CA 94560 Davis, CA 95616 Fresno, CA 93723 91745 <br />CAD980887418 CAD992446974 CAD846882 AD0yA432 <br />Ev. 'ra Env. Si Byergteen Env, Svc. ❑CFR ®CFR �j Groenieaf Env. Svc. <br />169WLS San Ped 745 ren <br />Bettuavia 94+1 ti 5iauson Ave. 33210 Western II --__ii 3474 Toyon Circle <br />Carson, CA 907 Saam Maria, CA 93454 Los An-ples, CA 90011 Union City, CA 94537 MOM <br />alloyy Sppringgss, CA 95352 <br />CAD931 CAD982446858 CAL0661I=I CAIA00091507 CAL0O 4411 <br />generator certifies that it has ostablisbed a program to reduce the volume or <br />Source: RfCollection Station ❑ Government quantity & toxicity of the hazardous waste to the degree determined by <br />❑ Marine ❑ Agricultural ❑ Industrial generator to be economically praetleabie. <br />I hembv cerft that I have read and have the authority to <br />" bind the above listed &enerator to the terms on the reverse <br />Retain sample # L C.0 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 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 requirements, and some out-of-state facilities that process used oil also meet those requirements. <br />These include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for <br />close 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 />and/nbt. these more stringent requirements. This notification is for information purposes only. <br />76W 1-20.0ev-1 �Swt� 3)�0�22 <br />d� <br />snature ritlt Name Rnitte # w DnrP. rrnr►rnrnr'c , ,onntnm PrR.. ns <br />