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WORK ORDER/SERVICE AGREEMENT <br />Evergreen Environmental Services N° 4 0 2 2 7 7 <br />dedicated to the protection of the environment <br />To schedule a pickup, call Send payment to: Sales Order # <br />800-596-9455 Evergreen Oil, Inc. <br />6$80 Smhh AVe., NBwark, CA EPA# CAD96241$262 P.O. BOX 30517 <br />16540 S. San Pedro St., Carson, CA EPA# CADS02413262 Lo, Angelcs, CA 90030-0517 Date', .7r+ /44-0' <br />GENERATOR/JOB LOCATION BILLrNG INFORMATION <br />ANA <br />'WASTE <br />CODE <br />MANIFEST QUANTITY UNITS PRICE AMOUNT <br />NUMBER <br />-ME <br />CASH ❑ CHECK Q <br />Gal. <br />NP G. -y.. <br />CA221 <br />Gal. <br /># <br />AD RESSADDRRSS <br />Gal. <br />RQ WeW. Combustible tibia. N.O.S. Nn <br />1991 al On—.i„n-t wit <br />CA221 <br />r00l/F002 <br />[ R CODE NO. <br />/ - <br />F <br />Waste Solids and Sludges <br />CITY` <br />STATE <br />ZIP CO. <br />CITY <br />STATE ZIP CO. PO # <br />PHONE NO. <br />Drum <br />Non-RCRA Hazardous Waste Solids (oily debris) <br />PHONE NO. <br />Drum <br />PROFILE NO. CUSTOMER EPA ID NO. <br />/ <br />Transportation <br />( ) <br />Hrs. <br />I kA4 VmL7S/ <br />PRODUCT <br />'WASTE <br />CODE <br />MANIFEST QUANTITY UNITS PRICE AMOUNT <br />NUMBER <br />Used oil, Non-R.CRA Hazardous Lubricating <br />CA22 <br />Gal. <br />Waste, Liquid Industrial <br />CA221 <br />Gal. <br />Used Auram div An6r—,- N--RCRA Hhurttous <br />w i 'd <br />CA 134 <br />Gal. <br />RQ WeW. Combustible tibia. N.O.S. Nn <br />1991 al On—.i„n-t wit <br />CA221 <br />r00l/F002 <br />(}al <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 Drulru <br />Drum <br />Transportation <br />Hrs. <br />Non Hazardous Water <br />Gal. <br />Glycol Bulk 50150 <br />Gal, <br />Glycol Buz Cono. <br />Gal. <br />TEST: Yam D Tech 4000-39t0L-ppm ❑ Clor D Tech 1000 <br />XPam ❑ Fail Halogen Dnectnr/Flamc Tcst ❑ Passail <br />Field Service Work Description: <br />Total Charges <br />Other: <br />Other: <br />vacua Services Tirne <br />Out Yard On Sitc Off Site <br />Off Load Start Off Load End Return to Y <br />Ir6-''88�FSmith <br />I Consolidated Manifest <br />en Oil, Inc. 17Evergreen Env. Svc. Evergreen Fnv, Svc, AJ5 Filter <br />Ave_ Road 30B Ll 4139 N. Valentine 15131 Clark Am <br />Newark, CA 94560 Davis, CA 95616 Fresno, CA 93722 Industry, CA 91745 <br />CAD990897419 CAr)982446874 CAD982446882 CAD77432 <br />a <br />F„vcrgreen Env, Svc. Evcryneen Env. Svc.1:1CFR a CFR ❑ Greenleaf Env. Svc. <br />16604 S, San cdro 745 A West Betteravia 944 E. Slauson Ave. 332t0 Western 3474 Toyon Circle <br />Carson, CA J0746 Santa Maria, CA 93454 Lns Ang�teles, CA 90011 Union� �C�.i�ty, CA 94587 Vallnv Springs, CA 95352 <br />CAI}9i3lri 20 CAD98244685R CAiA00110021 CALtx)0091507 CAL6W214411 <br />Generator ccnifcs that it has established a prugrun to reduce the volume or <br />Source: Collection Station ❑ Government quantity&toxicity of the hazardnus waste to the degree determined by <br />❑ Marine ❑ Agricultural ❑ Industrial generator to be economically pntcticable. <br />I hereby certify that_I_have read and have the authority to <br />bind the above listed generator to the terms on the reverse <br />Retain sample f ��J side of this form. <br />IMPORTANT NOTICE REGARDING THE INSPOSITION OF YOUR OIL. <br />Per California Health and Safety Code Secdon 25250.9, Evergreen hereby advise, customer that customer's shipment of tised oil may be <br />transported to a facility that is required to comply with fcdcral regulations applicable to management of used oil, but that is not required to <br />comply with the mote stringent requirements applicable to hazardous waste management facilities. California facilities that handle or process used <br />oil are required to meet those more stringent requirements, and sonic out-of-state facilitics that process used oil also meet those requirements. <br />These include more stringent leak detection and prevenuon requirements, enginccring certifications of tank integrity, and financial assurances for <br />CIAarc and accidental releases. It is lawful to send used oil to out-of-state facitities that comply only with federal used oil rnanagernent standards <br />d in( these more stringent requirements. This notification is for information purposes only. <br />.00.141 L , 7o% ,r ,4. D,7 <br />