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03/28/2007 09: 46 dulin accounting (FAXWz3r' kVAA-1 YYVRR VRLl'.iV c7GRYll,1.' HVRLI C.1Mirz1V'1 Evergreen Envil`,lmental Services .r� N-6 394739 dedicated to dte protection of rite environment r To schedule a pickup, call Send payment to: Sales Order 1 I 800-596-9455 Evergreen Oil,Inc: 6690 Smith Ave..Newark,CA EPA#CAD982413262 P.O.BOX 30517 r pe'1 16540 S.San Pedro SL,Carron,CA EPA#-CAD992413262 I—Angel-,CA 9DW"517 Date:r [ GENERATORfJOB LOCATION - BELLING INFORMATION N fE NAME CASH Q CHECK[} 0') If ADDR S - - ADDRESS i ' C OM�TC O?NO. C STA �tP CO. CITY STATE ZIP CO. # PHONE NO PHONE NO. 1 PROFILE NO. - CUSTOMER EPA m NO. ZA C. PRODUCT WASTE MANnewr I QUANTITY UNITS PRICE AMOUNT CODE NUMBER`. Used oil,Non-RCRA Hazmdous Lubricaung CA22 ZS— Gal- 7-60- -4 Waste.Liquid Industrial CA221 - Gal. - u,a ewwnwl..nwma,<.two-acne w.:,mo,. CA134 Gal. w m i w aQ wase G.m.k.tpua.N.O S.Nn G121 Gal. I 1'H3In IQl a'nnxnimv`J wI11,Fal t MoF()02 Oil&Water,?ton-RCRA Hazardous Waste Liquid CA221 Gal. Wane Solids sort Sludges Gal. I 11 CMilt Wash Out Each. chilled Used Oil Fillers Dntm Or LVE93ENCYSEE VICES Non-RCRA Hazardous;W.I.Solids(oily debris) CA23 Drum.' - Empty Drums Drum- ' Transponalion His. Non Hazardous Wtim, Gd. Glycol Bulk 50/50 7 Gut. Glycol Buzd Come. Gal. TEST: Clm D Tech 40002 -ppm Q-Clor D Tech 1000Pass Q Fall Q Halogen Detector/Flame Test Q Q Fail ♦r� I Field Service Work Description: Total Charges O herIt Other. Vacs ices Time Q Out of ardOn Site.—,Off Sim Off Load Stan Off Load End—Rculip m Yard TS F Consolidated Manifest Evergreen Oil.lnc. � Evergreen Env.Svc. ❑Evergreen Env.Svc.; � AIS Filter ❑ 6880 Smith Ave. Road 30B 4139 M Valentine 15131 Clark.Ave- , Newark,CA 94560 Davis,CA 95616 Fresno,CA 9372 Industry,CA 91745 CAD980887419 CAD982446874 CAD982446882i CADo00097432 Evergmen Env.Sv Evergreen Env.Svc. r--f CFR ❑-CFR []Gmitical Env.Svc. 16604 S.San 7J5 A West Beteravia LJ 944 E.Slauwn Ave. 33210 Wester 3474 Toyon Circle Carson,CA 90 6 Santa Maria,CA 93454 Los Angeles,CA 90011 Untoo City,CA 94587- Valleyy Springs,CA 95352 CAD9816964 CAD982446858 - - CAIAODtt(IOZt CAL000091507 CAI 14411 Generator certifies(hat it has established a program to reduce the volume or Source: UfCollection Station ❑Goverment quantity&toxicity of the hazardous waste to the degree determined by ❑Marine 0 Agricultural ❑Industrial generator to be economically practicable. /�. 1 hereby certify that I have read and have the authority to Retain Sample # 4b bind the above listed ecncratcr to the terns on the reverse side of this form. IMPORTANT NOTICE REGARDINGTHE DISPOSITION OF YOUR OE,. Per California Health and Safety Code Section 25250.9,Evergreen hereby advises customer that customer's shipment of used oil may he tmnsporled 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 rrmre stringent requirements applicable to hazardous waste;rnatlagemem-facilities California facilities that handle or process-used- oil are required to meet those more stringent requirements, and some out-of-slate facilities that process used oil also meet those requirements. se include more stringent leak detection and prevention requirements, engineering certifications of lank integrity. and financial assurances for lo. re and accidental releases. I[is lawfnt to send-used ort to-ou[-of-score faciNfres that compty only with federal 5 if nggerpgn ndards U more stringent requirements..This notification is for information purposes only. '-fv`� ((/�["/� /y��/\y slt 1/w¢y�( L� ZOO J-N-07 --9 er Signature rint Name Route# Date., Generator's Signatures Name DateName Date