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03/28/2007 09: 46 dulin accounting rAx 17c7oc7yavu _ rrvnn. vrair.nforrnv IL Fk%yRL n'V1JC1n i Evergreen Envi -imental Services N0 3 8 5 7 0 5 dedicated to+he prot`ecr�Non of the environment (107 Toschedule r�apickup,, callSend payment to: Sales Order # ""J�7 800-596-9455 Evergreen Oil, Inc. 6680 Smith Ave.,Newark,CA i EPA#CA0982413262 P.O.ROX 30517- 16640 S.San Pedro Sl.,Carson,CA EPAn GAD982At3262 Los Angeles.}CA-90030-0517 Date: �' I GENERATORIJOB LOCATION BILLING INFORMATION NAMENAME i CASH Q CHECKQ T«LSr # D ADDRESS CUSTOMER C E NO. j' TY TATE n/ZIP CO. CITY i STATE ZIP CO. Poll "IBJ ZOLI PHONE NO. ! PHONE NO! PROFILE NO. CUSTOMER EPA m NO. I PRODUCT WASTE MANIFEST QUANTITY - UNITS PRICE AMOUNT CODE NUMBER Used o0,Nun-RCRA Hamnlola Lubricating CA221 8( ( t Z14b Gal. a 56 Waste.Liquid Industrial CA221I Gal. f�'1 u,m aun,,.+l..n,.ua...xv„-xcuA xiumm.. CA134 Gal. IJ W»u Lf 1J 00 w-1 CunC,n:iHv tip-I Nn.S.NA�'. CA221 `-d. 159r 111 01 ma=1,rte,lul q matAma3 2097 Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. ' Waste Solids and Sludges Gal. JHN JUAUUIN L;UUr I Wash out Each RVICES Drained Used Oil Filters Drum - Non-RCRA H.eudous Waste Solids(oily debris) C_A223 Drum. Empty Drums Drum Transportation His, Non Hazamous Water Gal Glycol Bulk 50/50 Gat Glycol Bulk Co.- - Gal. •� TES Clor D Tech 40�ppin Q Clue D Tech 1On0�,ptiss E]Fail'❑Halogen Detector/Flame Test EllPass El Fail 2�•UD Fic l ivice Work Description: Tota( Char e5 Other. Vacuuodler m Services Time Out of Yard_On Site Off Site-Off Load Slut Off Load End Return to Yam TSDF Consolidated Munifest VEvergreen Oil,Inc. "Evcrgrten Env.Svc. Everg nv.Svc A1S Miter 6980 Smith Ave. ❑'Ruin 3011 ❑4139 N.Vakntire r ❑ 15111 Clark Ave. ❑ Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 1 Industry,CA 91745 __- CAD980887418 'CAD982446974 CAD982446882 CADW0097432 ❑ Evergreen Env.Svc. ❑I Evergreen Env.Svc. ❑CFR ❑ CIE - ❑Greenleaf Env.Svc. 16604 S.San Pedlo :745 A West Betteravai 944 E.Slauson Ave. 33210 Western 3474 Toyon Circle Corson,CA 90746 Same Maria.CA 93454 Los An11ggeeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 CAD981 96420 CADW446859 CALODDIIDD21 CAL000091307 CAL000214411 Generator certifies that it has established a program to reduce me volume or Source: Collection Station or quantity&toxicity or the hazardous waste to the degree determined by ❑Marine O Agricultural ❑Industrial Sencrarorto be economarrity,pmcticablc. I hereby certify that 1 have read and have the authority to Retain sample # C bind the above listed generator to the terms on the reverse 3 bide or this form. 1411 RTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. Per California Health and Safety Code Section 252509,Evergreen hereby advises customer that customer's shipment of used oil may be nansponed 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 are re inert to meet those more stringent requirements,and some out-of-state facilities that process used oil also meet those requirements. These include more stringent leak detection and prevention requirements,engineering certifications of lank integrity, and financial assurances for closure and accidental releases. It is lawful to send-used oil to out-of-state facilities thatcomplyonly with fcdemi used oil management standards and se mom stringent requirements.This notification is for information purposes only: - tZ.t Drive Signature Print Name Route#. Date Generator's S naNrc Print Name Dale