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Z. <br />WORK ORDEWSERVICE AGREEMENT <br />Evergreen Environmental Services N° 4 0 4 0 4 0 <br />dedicated to the protection of the environment <br />To schedule a pickup, cell Send payment to: Sales Order # <br />800-596-9455 Evergreen oil, Inc. <br />6880 Smith Ave., Newark, CA EPA# CAD982413262 P.O. BOX 30517 <br />16540 S. San Pedro St, Carson, CA EPAM CAD982413262 Los Angeles, CA 90030-0517 Date: ,� L.i <br />GEN19RATOR/1011 LOCATION BILLING INFORMATION <br />PRODUCT <br />WASTE <br />CODE <br />NAME <br />AMOUNT <br />CASH ❑ CHECK ❑ <br />CA12 <br />a2grmu Gal. <br />68Rp Smith Ave. <br />Waste, Liquid industrial <br />CA221 <br />ADDRE <br />NewA-. CA 94560 <br />ADDRESS <br />CA 134 <br />U O CODE NO. <br />CAD9RO887418 <br />f!-{ �J <br />CA221 <br />r01TW2 <br />Gal. <br />/T <br />C Y STATE <br />ZIP CO. <br />CITY <br />STATE.. 7.IP CO. <br />P # <br />(Tal, <br />Wash Out <br />PHONE NO. <br />PHONE NO. <br />PROFILE NO. <br />CUSTOMER EPA ED NO. <br />4 <br />CA223 <br />) <br />Empty Drvms <br />PRODUCT <br />WASTE <br />CODE <br />MANIFEST QUANTITY UNTTS PRICE <br />NUMBER <br />AMOUNT <br />Used oil, Non-RCRA Hazardous Lubricating <br />CA12 <br />a2grmu Gal. <br />68Rp Smith Ave. <br />Waste, Liquid industrial <br />CA221 <br />Gal, <br />NewA-. CA 94560 <br />Ural AuLo fie Antif�Nvs-RCRA Hszuduus <br />W— L uta <br />CA 134 <br />Gal. <br />CAD9RO887418 <br />RQQ <br />Iv9JW Wd mntnule ,Ledlqwh N <br />UaowAd N <br />CA221 <br />r01TW2 <br />Gal. <br />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />CA221 <br />Gal. <br />Waste Solids and Sludges <br />(Tal, <br />Wash Out <br />Each <br />Drained Used Oil Filters <br />Drurn <br />Nun-RCRA Hazardous Waste Solids (oily debris) <br />CA223 <br />Drum <br />Empty Drvms <br />Drum <br />Trensponauon <br />Hrs. <br />Non Hazardous ater <br />Gal. <br />Glycol Bulk 50/50 <br />Gal. <br />Glycol S Con'. <br />Gal, <br />TEST: Clor D Tech 4000 -ppm ❑ Clur D Tech 1000 <br />Pass ❑ R61 ❑ Halogen Detector/Flame Test Pass ❑ Fail <br />Field Service Work Description, <br />Total Charges <br />Other: <br />Other: <br />Vacuum Se vices Time <br />Out of Y d On Sitc Off Site <br />Offload Start Off Load End turn to Yard, <br />- <br />TS <br />[I Consolidated Manifest <br />Evergrrerr Oil, Inc. <br />I-1 Evergreen Env. Svc. <br />a Evugrecn Env. Svc. <br />I—I AIS Filter <br />68Rp Smith Ave. <br />I_I Road 30B <br />4139 N. Valentine <br />l—..I 15131 Clark Ave. <br />NewA-. CA 94560 <br />Davis, CA 950-16 <br />Fresno, CA 93722 <br />InCA CA 91745 <br />CAD9RO887418 <br />CAD982446874 <br />CAD982446882 <br />CAl]OOflO97432 <br />171 Evergreen Env. S c. a F.vcrgreen Env. Svc. CFR ❑CFR ❑ Greenleaf P,nv, Svc. <br />16604 S. San P 745 A West Betteravia 944 E. Slauson Ave. 3321U Western 3474 Toyon Cirt:le <br />Carson, CA 9( 4fi Sante Maria, CA 93454 Los Anggeles, CA IXX)I I Union City, CA 94587 Valley Springs, CA 95352 <br />CAD981fi0 CAD982446858 CZ2110021 CAL000091507 CALI�(l0 14411 <br />Genuettx certifies that it has established a program to reduce the volume or <br />Source, Collection Station 0 Government quantity & wxicity of the htk IIdous waste to the degree deterntincd by <br />❑ Marine ❑ Agricultural Q Industrial generator to he economically practicable. <br />1 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 #-3 T side of this form. <br />IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br />Per California Health and Safety Code Section 25250.9, 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 to management of used oil, but that is not required to <br />comply with the more stringent requirements applicable to hazardous waste management facilities, California facilitics that handle or process used <br />Iare required to meet those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements. <br />csc include snore stringent leak detection and prevention rcyuirements, engineering certifications of tank integrity, and financial assurances for <br />c{ sure and accidental releases. It is lawful to stand used oil to out-of-state facilities that comply only with federal used oil management standards <br />an npl these more stringentre uircmCnts. This notification is for information purposes only. <br />1-)36 1r: 71-g? , n NAIA V� :r- <br />