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WORK ORDER/SERVICE AGREEMENT Evergreen Environmental ServicesNO 3 $ 3 dedicated to the protection of the environment To schedule a pickup, call Send payment to: -4 A0 Sales (biles # 644-196-9455 Evergreen Oil, Inc. 6880 Smith Ave:, Newark. CAEPA# CAD982413262 P.O. BOX 30517 16540 S. San Pedro 3L, Carson, -CA EPA# CAD982413202 Los Angeles, CA 90030-0517 D GtNERATORIJOB LOCATION BILLIN"F'ORMATION OEM PRODUCT WASTE MANIFEST CODE NUMBER QUANTITY UNITS PRICE AMOUNT �r CA221 Z. Waste, Liquid Industrial FAF Gal. Used Au1o¢wdve Anaheezq N—RCRA Itaz &Us Ware L' u.,1 CAI 3Q Gal. R Wawa ComDusJDle Uq,.ld, N.O.S. NA '%W— nl Oi mri 'acted wieh talo CA221 POOI/EUn2 GaL Oil & Water, Non-RCRA Hazardous Waste Liquid OEM PRODUCT WASTE MANIFEST CODE NUMBER QUANTITY UNITS PRICE AMOUNT Used oil, Non-RCRA Hazardous Lubricating CA221 Gal. Waste, Liquid Industrial CA221 Gal. Used Au1o¢wdve Anaheezq N—RCRA Itaz &Us Ware L' u.,1 CAI 3Q Gal. R Wawa ComDusJDle Uq,.ld, N.O.S. NA '%W— nl Oi mri 'acted wieh talo CA221 POOI/EUn2 GaL Oil & Water, Non-RCRA Hazardous Waste Liquid CA221 Gal. Waste Solids and Sludges Gal, Wash Out Each Drained Used Oil Filters Drum Non-RCRA Ha7mdoua Waste Solids (oily dchris) CA223 Drum Empty Drums Drum 'transportation HES. Non Hazardous Water Glycol Bulk 50150 #Gall Glycol Bulk Cone. '1'PST:(7 Clnr D Tech ",X) ppm nor D 'tech ]000❑Pass ❑ Foil ❑ Halogen DetectorPT-tame Test ❑ Fuss ❑ Fail Field Service Work Description' otal Charges Other-. Other: vacuum Services Time Out of Yard On Site Off Site Off Load Starr Off Load Etu1 Return to Yard TSDF ❑ Consolidated Manifest Evergreen oil, (ne. Even Env. Svc. ❑ Evergreen Env. Svc. ❑ A1S Filter 6880 Snuth Ave ❑ Ruad 30B 4139 N. Valentine 15131 Clark Ave. Newark, CA 94560 Davis, CA 95616 Fresno, CA 93722Indus��yy� CA 91745 CAD980887418 CAD982446874 CAD982.446882 CADO011097432 7 J Evergreen Env. Svc. ❑Evergreen Env. Svc. [:jCFR [:jCFR D Greenleaf Env. Svc. tu—� 1fi604 S. San Pedro 745 A West Bettentvia 944 E. Slauson Ave, 33210 Western 3474 Toyon Circle Cation, CA 90746 Sunta Maria, CA 93454 Los Annggeles, CA 90011 Union Cityty. CA 94587 Valleyy Sppriaggs, CA 95352 CAD981fi9fi42t1 CAU982446858 CAIAOf1110021 CA100009[507 CAiA00214411 Generator certifies that it has established a program to reduce the volume or rce: ❑ Collection Station ❑ Government quantity & toxicity of the hazardous waste to the degree determined by Sou ❑ Marine ❑ Agricultural ❑ Industrial generator to N economically practicable. I hereby certify that I have read and have the authority to bind the above listed generator to the terms on the reverse Retain sample # side of this form. IMPORTANT NOTICE REGARDING TH.L DISPOSITION OF YOUR OIL. Per California Health and Safety Code Section 25250.9, Evergreen hereby advises customer that cuslomcr's shipment. of used oil may be transported to a facility that is required to comply with federal regulations applicable to management of used ail, but that is not required to comply with the morc stringent requirements applicable to hazardous waste management facilities. California faeilitic, that handle or process used oil are required to meet those more stringent requirement.,, and some out-of-state facilities that process used oil also meet thosc rcquirement,. These include more stringent leak detection and prevention requirements, engineering cerriticmions of Lank integrity, and financial assurances for closure and accidental releascs. It is lawful to send used oil to out-of-stntc facilities that COrnply only with federal used oil managerncm standards and not these morc stringent rcquircmetntS. This notification is for information purposes only.