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1 WORK ORDERISERVICE AGREEMENT
<br />Evergreen Environmental Services N° 399701
<br />dedicated to the protection of the environment
<br />To schedule a pickup, call Send payment to: Salesr r
<br />Q de #
<br />800-596-9455 Evergreen Oil, Inc.
<br />6880 Smith Ave., Newark, CA EPA$ CAD982413M2 P.O. BOX 30517
<br />16540 S. Sart PedroSt.. Caram, CA EPA$ CAD982413262 Los, Angeles, CA 90030-0517 Date: _
<br />GENF,RATORIJOB LOCATION BILLING INFORMATION
<br />PRODUCT
<br />WASTE
<br />CODE;
<br />MANIFEST
<br />NUMBER QUANTITY UNITS PRICE
<br />NAME
<br />Used nil, Non-RCRA Hazardous Lubricating
<br />CASH ❑ CHECK ❑
<br />Gal.
<br />880 Smith ave.
<br />Waste, Liquid Industrial
<br />CA221
<br />Gal.
<br />11
<br />An
<br />a
<br />Ft>�14n•
<br />Gal.
<br />Gail.
<br />ADDRESS
<br />wo wwa Comb.otiMe L.pui4 N.O.S. NA
<br />19§3 In lhl rnnunt I w
<br />CUs O ODE NO.
<br />C STATE
<br />ZIP
<br />CO.
<br />CITY
<br />STATE ZIP CO.
<br />PO #
<br />c4
<br />Gal -
<br />Wash Out
<br />PHONE NO,
<br />Drained Used Oil Filters
<br />PHONE, NO.
<br />Drum
<br />PROFILE NO. I
<br />CUSTOMER EPA ID NO,
<br />— 5FV/Z
<br />Drum
<br />)
<br />Drum
<br />Hrs.
<br />PRODUCT
<br />WASTE
<br />CODE;
<br />MANIFEST
<br />NUMBER QUANTITY UNITS PRICE
<br />AMOUNT
<br />Used nil, Non-RCRA Hazardous Lubricating
<br />CA22
<br />Gal.
<br />880 Smith ave.
<br />Waste, Liquid Industrial
<br />CA221
<br />Gal.
<br />Newark, CA 94560
<br />Used Auoo d,[ M,ar,eG,e. Nim-RCRA H—d..
<br />w
<br />CA
<br />Gal.
<br />Gail.
<br />CAD980887418
<br />wo wwa Comb.otiMe L.pui4 N.O.S. NA
<br />19§3 In lhl rnnunt I w
<br />pI�WM12
<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 Utums
<br />Transportation
<br />Drum
<br />Hrs.
<br />Non Hazardous WAr
<br />Gal.
<br />Glycol Bulk 5(v'so
<br />Gal,
<br />Glycol Bu Conc.
<br />Gal.
<br />TEST: Clor D Tech 4000404-1ppm ❑ Clor D Tcch 1000
<br />Pass ❑ Fail ❑ Hulogen Octeetor/Ramc Test ❑ pa ❑ Fail
<br />Field Service Work Description:
<br />Total Charges
<br />Other.
<br />Other:
<br />Vacuum svvices Time
<br />Out of On Site Off Site
<br />Oft' Lead Start Off Load End Retunl to and
<br />❑ Evergreen Lriv. S .-vergree, Env. Svc. ❑ Cd R ❑CFR ❑ Grcenlcaf Erw. Svc.
<br />166(A S. San P ro 745 A West 1lctteravia 944 E. Slauson Ave, 33210 Wcstcrn 3474 Tuynn Circle
<br />Carson, CA . 4h Santa Mania, CA 93454 Los. Angeles, CA 9001 1 Union � �C�i�tyy, CA 94587 Valleyy' Syp rings, CA 95352
<br />CA09816 0 . CAD982446858 CAL000110021 CAL000091507 CALt10(yL14411
<br />Ocneralor certifies that it has established a program to reduce the volume or
<br />Source: Cd Collection Station ❑ Government quantity dt toxicity of the hazardous waste to the degrrc determined by
<br />C1 Marine ❑ Agricultural © Industrial generator to be economically practicable.
<br />I hereby certify that I have read and have the authority to
<br />bind the above listed generator to the terns on the reverse
<br />Retain sample # 2_i . �' side or this furor.
<br />IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL.
<br />Per California Health and Safety Code Section 252511.9, Evergreen hereby advises customer that customer's shipment of used oil may he
<br />transported to a facility that is required to comply with federal regulations applicable Lo management of used oil, but that is not required to
<br />comply with the more stringent requirements applicable to hazardous wade management facilities. California facilities that handle or process used
<br />oil are required to tract those more stringent requirements, and some out-of-state facilities that process used oil also meet those. requirements.
<br />The include rnorc Stringent leak detection and prevention requirements, engineering; ccrtificarions of tank integrity, and financial assurances for
<br />1 ur and accidental releases. 11 is lawful l0 Sind used oil to oil of -stale facilities that comply only with IcdcraI used oil management standards
<br />an n these more stringent requirements. This notification is lur information purposes only.
<br />11
<br />Consolidated Manifest
<br />;rEve rgreenOil,Inc.
<br />Evergg*reeeen Env. Svc.
<br />f i Evergreen Env. Svc.
<br />❑ AJS Filter
<br />880 Smith ave.
<br />Road 3013
<br />LJ 4139 N. Valentine
<br />15131 Clark Ave.
<br />Newark, CA 94560
<br />Davis, CA 9 616
<br />Fresno. CA 93722I......t1y
<br />CA 91745
<br />CAD980887418
<br />CAD982446874
<br />CAD982446882
<br />CAD(l)97a32
<br />❑ Evergreen Lriv. S .-vergree, Env. Svc. ❑ Cd R ❑CFR ❑ Grcenlcaf Erw. Svc.
<br />166(A S. San P ro 745 A West 1lctteravia 944 E. Slauson Ave, 33210 Wcstcrn 3474 Tuynn Circle
<br />Carson, CA . 4h Santa Mania, CA 93454 Los. Angeles, CA 9001 1 Union � �C�i�tyy, CA 94587 Valleyy' Syp rings, CA 95352
<br />CA09816 0 . CAD982446858 CAL000110021 CAL000091507 CALt10(yL14411
<br />Ocneralor certifies that it has established a program to reduce the volume or
<br />Source: Cd Collection Station ❑ Government quantity dt toxicity of the hazardous waste to the degrrc determined by
<br />C1 Marine ❑ Agricultural © Industrial generator to be economically practicable.
<br />I hereby certify that I have read and have the authority to
<br />bind the above listed generator to the terns on the reverse
<br />Retain sample # 2_i . �' side or this furor.
<br />IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL.
<br />Per California Health and Safety Code Section 252511.9, Evergreen hereby advises customer that customer's shipment of used oil may he
<br />transported to a facility that is required to comply with federal regulations applicable Lo management of used oil, but that is not required to
<br />comply with the more stringent requirements applicable to hazardous wade management facilities. California facilities that handle or process used
<br />oil are required to tract those more stringent requirements, and some out-of-state facilities that process used oil also meet those. requirements.
<br />The include rnorc Stringent leak detection and prevention requirements, engineering; ccrtificarions of tank integrity, and financial assurances for
<br />1 ur and accidental releases. 11 is lawful l0 Sind used oil to oil of -stale facilities that comply only with IcdcraI used oil management standards
<br />an n these more stringent requirements. This notification is lur information purposes only.
<br />11
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