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J, WORK ORDER/SERVICE AGREEMENT i7 Evergreen Environmental Services N° 404915 dedicated to the protection of the environment To schedule a pickup, call Send payment to: Sales Order # 800-596-9455 Evergreen Oil, Inc. 6860 Smith Ave„ Newark, CA EPA# CAD982413262 P.O. BOX 30517 16540 S. San Pedro St., Caraon, CA EPA# CA0982413262 Los Angeles, CA 90030-0517 Date: GENERATORIJOB LOCATION BILLING INFORMATION wu WASTE CODE NAME UNITS PRICE AMOUNT CASH ❑ CHECK Va. On., �'� Gal. Gal. Used Mk,Ii— A -f-- N--RCRA H—dauc Wuf LI aid # ADDRESS Gal. ADDRESS cA221 FOGI/Fn02 CU `T R ODE NO, C STATE ZIP CO. CI'T'Y STATE, ZIP CO.PO # Waste Solids and Sludges 7 c� Gal. Wash out PH ONE NO, PRONE NO. Drained Used Oil Filters PROFILE NO. CUSTOMER EPA ID NO. Drum Non-RCRA Hazardous Waste Solids (oily debris) CA223 Drum Empty Drunig PRODUCT WASTE CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT Used oil, Non-RCR.A Hazardous Lubricating Waste, Liquid Industrial CA22 CA221 �'� Gal. Gal. Used Mk,Ii— A -f-- N--RCRA H—dauc Wuf LI aid CA 134 Gal. RV W.... CaMushGb Liquid, N.O.S. NA wAh f,I cA221 FOGI/Fn02 GRI. Oil & Water, Non-RCRA Hazardous Waste Liquid CA221 Gat. Waste Solids and Sludges Gal. Wash out Each Drained Used Oil Filters Drum Non-RCRA Hazardous Waste Solids (oily debris) CA223 Drum Empty Drunig Drvm T importation Hrs. Non Hazardous WofGal. Glycol Bulk 500 Gal• Glycol ButzCone. Cal• TEST: Clor D Tech 4000Zg$i_ppm ❑ Clot D Tech low Pass ❑ Fail ❑ Halogen DctectorlPlame T ❑ Pass ❑ Fail Ficld Scrvioc Work Description: I Total Charges Other: Other: Vacuumrvices Time Out of and On Site off Site Off Load Stan Off Load End etum to Yard 7&ergreen Z Consolidated Manifest Oil, Inc. Evergreen Bnv, Svc. Ever green Env. Svc:. ❑ AJS Filter HOith Ave. ❑ Rnad 3OB ❑ 4139 N. Valentine 15131 CIS Ave. Newark, CA 94560 Davis, CA 95616 Fresno, CA 93722 Industry, CA 91745 CAD98088741y CA179K446874 CAD982446W CAIXJli0097432 �� Evergreen Env, c. Evergreen Env, Svc. C1'R CFR Greenleaf Env. Svc. 1 1 16604 S. San P ro ❑ 715 A West Bcacravia ❑ 944 E. Slauson Ave. ❑ 33210 Westcm 3474 Toyon Circle Carson, CA 46 Santa Maria, CA 93454 Los Anggeles, CA 90011 Union City CA 94587 Valleyy Sppnnngs, CA 95352 CAD98169 _0 CAD982446858 CAL000110021 CAL000091507 CALO(102IV I GCnCrat0 certifies that it has established a prot,ram to reduce the volume or Source: Collection Station 0 Government quantity & toxicity of the hazamduus waste io the degree dctcrrnincd by ❑ Marine ❑ A ricultural 0 Industrial generator to be economically practicablc- I hereby certify that I have read and have the authority to bind the above listed generator to the terms an the reverse Retain Sample # side of this form. IMPORTANT NOTICE REGARDING THE, DISPOSITION OF YOUR OIL. Per California Health and Safety Code Section 25250.9, Evergreen hereby 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 requiremcnts applicable to hazardous waste management facilities. California facilities that handle or process used oil are required to meet those more stringent requirements, and tome out-of-state tacilitics that princess used oil also meet those requirements. sc include mu ore stringent leak detection and prevenou requiremcnts, engineering certifications of tank integrity, and financial assurances for n are and accidental releases. It is lawful to send used oil to out -of -slate facilities that comply only with federal used oil management standards n not these more stringent requirements. This notification is for information purposes only.