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WORK ORDER/SERVICE AGREEMENT <br />Evergreen Environmental Services N_ 394811 <br />dedicated to the protection of the environment <br />To schedule a pickup, call Send payment to: Sales Order # <br />500-596-9455 Fvcrgrccn Oil, Inc. <br />BBBO Smith Ave., Newark, CA EPAtf CAD082413262 P.O. BOX 30517 <br />16540 s. San Pedro St., Carson, CA EPA# CADW2413262 Los Angeles, CA 90030-0517 Date: ,� . T•I • �� <br />GENERATORIJOB LOCATION BILLING INFORMATION <br />PRODUCT <br />WASTE, <br />WASTE <br />NAME <br />UNITS PRICE AMOUNT <br />CASA L]CHECK ❑ <br />.- <br />Wt. <br />Ual. <br />Waste, Liquid tnduhlrial <br /># <br />ADDRESS <br />r <br />ADDRESS <br />CA 134 <br />NO. <br />Gal_ <br />.l r* <br />CA221 <br />FOOM7002 <br />1 � <br />CIT <br />STATE ZIP CO. <br />CITY <br />STATE ZIP CO. <br />PO # <br />Gal. <br />Wash Out <br />PHONE NO. <br />Each <br />PHONE NO. <br />PROFILE NO, <br />CUSTOMER EPAID NO. <br />Non-RCRA Hazardous waste Solids (oily debris) <br />Z <br />( <br />Drum <br />I <br />CAL'ei4o7_3 <br />PRODUCT <br />WASTE, <br />WASTE <br />MANIFEST <br />NUMBER QUANTITY <br />UNITS PRICE AMOUNT <br />Used oil, Non RCRA Hazardous Lubricating <br />CA22 <br />Ual. <br />Waste, Liquid tnduhlrial <br />CA221 <br />Gal. <br />Used Aa. a Anat,—. N—RCRA H.-3— <br />WaaEe u d <br />CA 134 <br />Gal_ <br />1111111- Cam6usRl,le Liquid, N.0.3. NA <br />1777 111 ! '1 nu,unu,W <br />CA221 <br />FOOM7002 <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 />Non-RCRA Hazardous waste Solids (oily debris) <br />CA223 <br />Drum <br />Empty Darns <br />]arum <br />Transponarian <br />1n. <br />Non Hazardous. Water <br />GaL <br />Glycol Bulk Af 50150 <br />Gal. <br />Glycol Bulk/Conc. <br />Gal. <br />TEST: Clor D Tech 400(i74i;6_ppm [:3 Clor D'I'ech 1000 <br />Pass ❑�10 Halogen Detector/Flame; Teat ❑ PAss ❑ Fail <br />Field Service Work Description: <br />Total Charges <br />Other: <br />other: <br />vacuum S ices Time <br />Out of Y On Site Off Site <br />Off Load Stan Off Load End <br />Rctum to Y <br />YF <br />[�Colzsalidated Manifest <br />rgreen Oil, Inc. j� Fvc wn F,nv, Svc. EverpseenEnv.Svc.ElAJSFilter0 Smith Avc. UU Road 30B 4139 N. valeatirte 15131 Claris Ave. <br />Newark. CA 94560 Davis, CA 95616 Fresno, CA 93722Industrfyy� CA 91745 <br />CADSI M887a18 CAD982446814 CAD982446882 CAD00lXY)7432 <br />Evergreen Env. S n f7vergWell Env. Svc, ❑ CFR ❑ CFR 171Greenleaf Env, Svc. <br />16604 S. San to J 745 est Beueravia 944 E. Slauson Ave. 33210 Western 3474 Toyon Circle <br />Carson, CA 46 Santa Maria, CA 93454 Los AI,geles, CA 90011 Unita City, CA'14587 ValleyY �SppanBs, CA 95352 <br />CAD9816 0 CAD982446f158 CZMIItXr21 CAL(XXX)91507 CAL000214411 <br />Generator certifies that it liar established a program to rrduce the volume ur <br />�011rCe: Collection Station Q Government quantity & toxicity of the hazardous waste to the degree determined by <br />❑ Marine ❑ A ricultural ❑.industrial generator to be economically practicable. <br />I hereby terrify_that I have read and have the authority to <br />bind the above listed generator to the terms on the reverse <br />Retain sample #!S side of this form. <br />MPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br />Per California Health and Safety Cade Section 25250.9, Everb7ccn 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 managgment of used oil, but that is not required to <br />comply with the more stringent mquircments 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 />Thcsc include more stringent Icak detection and prevention requirement, engineering certifications of lank integrity, aril fur:u7cial assurances for <br />closure and accidental releases. It is lawful to send used ail to out-of-state facilities that comply only with federal used oil management standards <br />and not these more stringent requirements. This notification is for information purposes only. <br />„Z\ -n"1 10 , (?\ 1 ' l�v.,tiW►+•+o'' <br />