COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

WORK ,:9,,Eveen En��inen Services dedicated to the proiec r of the environment To schedule a pickup, call Send payment to: Sales Order # 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: _ !'TATL'n All' T)/T1-IID T 1-10AmTnXT RTT.T.TNC, TNFORMATION NA y 4 1 NAME CASH ❑ CHECK (� Y!� CA220p ® # A DRESS i F ADDRESS CUSTOMER CODE NO. hr 1 Ll Lf r. F FooA221 Gal, CITY STATE ZIP CO. CITY STATE ZIP CO. PO # Non Hazardous Water Gal. ^PHONE NO. _�A[g� PHONE NO. PROFILE NO. CUSTOMER EPA M NO. WashOut Each PRODUCT I ASTE E I NUMBER I MANIFEST QUANTITY UNITS PRICE I AMOUNT Used oil, Non-RCRA Hazardous Lubricating CA221 7-' ,,. f, ` '7), Gal. Waste, Liquid Industrial CA220p ® Gal Used Automotive Antifreeze, Non-RCRA Hazardous Waste Liquid CA 134 Gal. RQ Waste Combustible Liquid, N.O.S. NA 1993 ill (Oil contaminated with halogens) FooA221 Gal, Oil & Water, Non-RCRA Hazardous Waste Liquid CA223 Gal. Non Hazardous Water Gal. Waste Solids and Sludges Gal. WashOut Each Pressure Washer/Steam Cleaner Day Transportation Fuel Surcharge Glycol �,nc./Specify cify Product Glycol Product p TEST: Clor D Tech 4002 ppm ❑ Clor D Tech 1000 Retain sample # Required Field Service Work Description: Other: Other: E] Fail Hrs. Gal. Gal. Total TS IA` Consolidated Manifest DRIVER CHECKLI�` Evergreen Oil, Inc. Evergreen Oil, Inc. - Davis Evergreen Oil, Inc. - Fresno ❑ Time In Time Out 6880 Smith Ave. ❑ Road 30B ❑ 4139 N. Valentine ❑ Tank/Drum Properly Labeled Newark, CA 94560 Davis, CA 95616 Fresno, CA 93722 CAD980887418 CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked ❑ Evergreen Env. Svc. ❑ EvetgleenU,Inc. -Santa Maria El ❑ House Keeping - Tank/Drum Clean 16604 S. San Pedro 745 A West Betteravia ❑ Other Services Checked: ❑ Oil, ❑ Filters/Drums, ❑ Antifreeze Carson, CA 907 Santa Maria, CA 93454 ❑ Called in other services needed ❑ Oil, ❑ Filters/Drums, ❑ Antifreeze CAD9816964 CAD982446858 Generator certifies that it has established a program to reduce the volume or Source: LdCollection Station ❑ Government quantity & toxicity of the hazardous waste to the degree determined by ❑ Maiine ❑ 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. Cafifornia facilities that handle or process used oil aretequired to meet those more stringent requirements, and some out-of-state facilities *at process fused oil also meet those requirements. These i�lclude more stringent leak trf detection and prevention requirements, engineering cercationsofltank integrity, and financial assurances for 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 and`not these more stringent requirements. This notification is for information purposes1only. t _ ; f 6,4"T":•`-^�.,q,F.,-' J..r - Signature Print Name Route # Date Generator's Signature Pnnt Name Date