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WORK ORDER/SERVICE AGREEMENT 4 Evergreen Environmental Services N' 404898 0dedicated to rhe protection of the environment To schedule a pickup, call Send payment to: Sales Order # 800-596-9455 Evergreen Oil, Inc. 8880 Smith Ave., Newark, CA EPA* CA0082413262 P.O. BOX 30517 16540 S, San Pedro St., Carson, GA SPAN CAD9824132e2 Los Angeles, CA 90030-0517 Date: GENERATORIJOB LOCATION BILLING INFORMATION / •� ` MANIFEST QUANTITY NUMBER UNITS PRICE NAME CASH ❑ CHECK ❑ CA22 " Gal, Waste, Liquid Industrial CA221 ADDRESS W C1xJ Rut -dAmit—, N.IRCRA H�—d— wum ua ADDRESS EUS' ' 114E UDE NU. Gal. Ran mlwsGhk figvid. N.O.SNA WineOClnm...... 11l es 10'-4 Gal. STATE 'LIP CO. CITY STATE ZIP CU. PO PHONE NO. Gal. PRONE NO. Wash Out PROFILE NO. I CUSTOMER EPA HN0. /L Drained Used Oil Filters ( ) �2�/.�S PRODUCT WASTE CODE MANIFEST QUANTITY NUMBER UNITS PRICE AMOUNT Used oil, Non-RCRA Hazardous Lubricating CA22 " Gal, Waste, Liquid Industrial CA221 Gal. C1xJ Rut -dAmit—, N.IRCRA H�—d— wum ua CA 134 Gal. mlwsGhk figvid. N.O.SNA WineOClnm...... 11l es CA221 fp fM2 Gal. Oil & Water, Non-RCRA Hazardous waste Uquid CA221 Gil. Waste Solids and Sludges Gal. Wash Out Each Drained Used Oil Filters Drum Non-RCRA Hazardous Waste Solids (oily debris) CA223 Thum Empty Drums Drum Transportation Hrs. Non Hazardous V&r Gal. Glycol Bulk 50/,50 Gal. Glycol Bu Conc. Cal. TEST: 10or D Tech 4 ppm ❑ Clor D Tach 1000 RfPass Q Fail © Halogen Detector/Flame Test F—]/,. 11 Fail Field Service Work Description: Total Charges Other: Otho: Vacuum Sc Rlecs Time Out of On Site Off Site Off Load Start Off Load tnd Return to ani T;Sl 2rConsolidated Manifest Evergreen Oil, Inc, Evergreen Env. Svc. Evergreen Env. Svc, AJS Filter 6880 Smith Ave, Road 308 4139 N. Valentine 1:115131 Clark Ave. Newark, CA 94560 s, CA 95616 Fresno, CA 93722 Industry, CA 91745 CAD98088741R CAD982446874 CAD982446882 CADXl0097432 ❑Evergreen Env, Svc Evergreen Env. Svc. n CFR CVR a Greenleaf Env, Svc, 16604 S. San PC 745 A West Betteravia IJ 944 G. Slauson Ave. 33210 Western 3474 Toyon Circle Carson, CA 90 6 Santa Maria, CA 93454 Los Angeles. CA 90011 Union City, CA 94587 Valley Springs, CA 95352 CAU98169 CAD982446858 CAi,(.NI10021 CALU(X)0§1507 CALOW21441["1 Generator certifies that it has established a progrvn to reduce the volume or Source: Collection Station El Government quattity & toxicity of the hoz dous waste in the degree deterntineA by ❑ Marine ❑ Agricultural ❑ Industrial generator to he economically practicable. JJ�� I hereby certify that I have read and have the authority to Retain sample # L V �� bind the above listed generator to the terms on the reverse side of this form. IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. Per California Health and Safety Code Section 252$0.9, Evergreen hrrcby advises Customer that customer's shipment of used oil may be transported to 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 rt=t those more stringent requirements, and some out-of-state facilities that process used oil also tneet those requirements. hese include more aringeni leak detection and pTCvcntion requirements, engineering certifications of tank integrity', and financial assurances for sure and accidental releases. It is Lawful to send used Oil to 011t-Of-staic facilities that Comply only with fcdcral used oil anagement standards Ulse more stringent re cements. This notification is for information purposes onlv.