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WORK ORDER/SERVICE AGREEMENT A110, Evergreen Environmental Services N9 398055 dedicated to rhe prarec•tion of the environment To schedule a pickup, call Send payment to: Sales Order # 800-596-9455 Evergreen Oil, Inc. 600 Smith Ave., Newark, CA EPA# CAD982413262 P.O. BOX 30517 � . � �b% 16W S. San Pedro St., Carson, CA EPA# CA0962413262 Los Angcics, CA 90030-0517 Date: GENERATOR/JOB LOCATION BILLING INFORMATION N WASTE CODE NAME CASH ❑ CHECK 2 AMOUNT Used oil, Nou-RCRA Hazardous 1,uhrieating CA22 A DRESS j'� ADDRESS CVSj)0lAEE9 COW NO. rya.�// CA221 CI STATE ZIP CO. CITY STATE ZIP CO. PO 0 Gal. PHONE NO. CA221 F000P002 PHONE NO. PROFILE NO. CUSTOMER� PA LD NO. -1;P1117- Oil A Water, Nan-RCRA Hazardous Waste Liquid ( ) PRODUCT WASTE CODE MANIFEST NUMBER QUANTITY UNITS PRICE, AMOUNT Used oil, Nou-RCRA Hazardous 1,uhrieating CA22 8 j'� Gal. Waste, Liquid Industrial CA221 Gal. USM AUm Ve Andr e M Nan-RCRA Hain d= W CA l34 Gal. RQ Wilt. C—babble Uwid. N.O.S. NA 1993 111 AY eon L—d I b . nc CA221 F000P002 Gal. Oil A Water, Nan-RCRA Hazardous Waste Liquid CA221 Gal, Waste Solids and Sludges Gal. Wash Out Foch Drained Used Oil Filters Drum Nun-RCRA Hazardous Waste Solids (oily debris) CA223 Drum Empty Drums Transportation Drum Hrs. Non Hazardous r Gal. Glycol Bulk 50150 Gal. Glycol Bu Cone. Gal. TEST: Clur D Tech 4000 -7.49t -ppm ❑ Clor D Tech 1000 Pass ❑ Fail Halogen Dctcctnr/Flame Test ❑ P ❑ Fail Field Service Work Description: Total Charges Other; Other: Vacuum, rviccs'I}mc Out of rd On Site Off Site Off Load Start Off Load End Rourn t Xard TS Z Consolidated Manifest Evergreen Oil, Inc. Even Env. Svc. ❑ Evergreen Env. Svc. ❑ AJS Filter 6880 Smith Avc. ❑ Road 30B 4139 iv. Valentine 15131 Claric Avc, Newark, CA 94560 Davis, CA 95616 Fresno, CA 9371? IndustryCA 91745 CAD980987418 CAD982446874 CAD982446982 CAD(XXi)97432 Evergreen Env. c. Fyvergrxn Env. Svc. CFR CFI2 Greenleaf Env. Svc. ❑ IMS San edit, ❑ 745 A West Betteravia ❑947 E. Slauson Ave. ❑ 33210 Wcsterrt 3474 Toyon Circle Cason, CA 746 Santa Maria. CA 93454 Los Angeles, CA 90011 Union City, CA 94587 Valley Springs, CA 95352 CAD9816 20 CAD982446858 CAL000110021 CAL0t10W M7 CAL00021441 I Generator certifies that it has established a progralrt to reduce the volume or Source: A Collection Station ❑ Government quantity & toxicity of the hazardous waste to the degree determined by ❑ Marine ❑ Agricultural ❑ Industrial generator to be economically pnlcticable. I hereby certify that I have read and have the authors to hind the above listed generator to the terms on the reverse Retain sample # I Cr4 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 custorner's shipment of used oil may be transported W 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 required to meet those more stringent requirements, and some out-of-state facilities that process used oil also mcet those requirements. These include more stringent leak detection and prevention requirements, engineering certification~ of tank integrity, and financial assurances for sure and accidental releases. It is lawful t0 send used oil to out-of-state facilities that elirnply only with federal used uil management standards an not thesc more stringent requirements. This notification iS for information purposes ottly.