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--"May. 27. 2010 -10. 18AM No. 2836 P. 1/1 <br /> WORK ORDEI#ERrV IC E AGREEMENT <br /> Evergmen Envitnmentalselviemo <br /> N- 522878 <br /> dedicated to the protection of the utvimrrmenl <br /> To schedule a plekup,call Send payment to: Sales Order# V <br /> 800-596-9455 Eveqr-en Oil;Inc. <br /> 6880 Smith Are.,Newry CA IDPH/CAD997A 13262 P0.BOX 30217 <br /> Af 16540 S.Stn Pedro Sl., rs <br /> Caon,CA jEpA r CAIo9tt2a 11262 Los Angeles;.CA 9W30-0517 Date: <br /> GENERATORIJOB LOCATION BILLING TWORMATION <br /> NAME CASH❑ CHECK❑ <br /> rK <br /> ADDRESS ADDRESS C Ori COYE N0. <br /> -3 p Iia 5 F (J <br /> CITY STATE ZIP CO, CITY STATE ZIP CO. PO A <br /> �sZ!✓I u <br /> PHONE 140. PHONE NO, PROFILE NO. CUSTOMER EPA ID NO. . <br /> PRODUCT WASTE MANIFEST QUANTI.n, UNITS PRICE MOUNT <br /> CODE NUMBER <br /> IVIO <br /> Used oil,Non-RC13A Hazardous Lubricating CA221 1 <br /> Waste,liquid Industrial CA221 Gal.. <br /> vrara'[Jae°M"'m"'e'1rMif^s�c.Ho--kru"io"'am CA 134 Gal. <br /> aQ w.r«q�a awtr r rYA t NA rwiffi o¢ Gal. <br /> I"]at a.r..rrer.:r <br /> Pit A Water,Non-RCRA Ilaztdan9 Waste liquid CA221 Gal.. <br /> Waste Solids snd Sludges Gal. <br /> Wash Oui Each <br /> Drained Used Oil Filters Drum <br /> Non-RCRA hazardous V&ie Solids(oily debris) CA223 Drum <br /> Pmpty Drums Dmm <br /> Tmnspatation <br /> Non Hazardous Water. Gal, <br /> Glycol Bulk Of50 Gal. �. <br /> Glycol Bulk, ". Gal.. <br /> TEST:❑'C1or Pitch 400Q-----ppm ❑Cloy D 7beh 1000❑Pace❑Pail❑Halogen Deteaor/Flime'CLst ❑Pau -❑Fail <br /> Field Service Work Description: Total es <br /> Other: Vi <br /> Other. -Vacuum Services Ser•ices'Time r J <br /> Out of yard On Site Off Site Off Load Stan Off Load End Rctum to'Ymd DNI'1,r <br /> TSI) ❑ Consolidated Manifest <br /> ver Oil,Inc. Bvugteen Env.Svc. B Erie.Src. AJS Piller ❑ <br /> 880 Sm th Ave ❑ Road 30B ❑4 I]9 N YakMine ❑ 15131 Clark Ave. <br /> NcwarK CA 94S60 Davis.CA 95616 Fresno,CA 93727 tnduary.CA 91745 <br /> CAD980987418 CAD912446874 CAn982446882 CAD000097432 <br /> ❑ EvergrS Ia Svc. ❑ EveJgreea Env.Svc. ❑CFR ❑ CCIPRt0 � ❑Greenleaf Env.Svc. <br /> E,=S S.Sas Pedro 745 A West BW eravia 944 E-Slauson Avc. oyott Omit <br /> Carson,CA 90746 . Santa M",CA 93454 las An CA 90011 Union Crrtyy.CA 945#7 Valle Spprri�s,CA 95352 <br /> CAD9816i96420 CAD982 46858 110021 CAL000091507 CAM214411 <br /> Generator ceAMes that it has established a program to reduce ttre volunle or <br /> Source: ❑Collection Statlon 0 GoveRlment quantity A toxicity of the hazardous waste to the degree determined by <br /> 0 Marine ❑ Agricultural ❑ Industrial gerientor to be economically practicable. <br /> I hereby certify that I have read and have the authorily� <br /> bind tle>!above listed generator to the terms on the reverse <br /> Retain sample# side of this form, <br /> Ir"ORTANT 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 be <br /> transporter 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 morn stringent requirements applicable to hazardous waste management facilities.California facilities that handle or process used <br /> oilare m wired to meet those more stringent mquiminents,and some out-of-state facilities that process used oil also meet those requirements.. <br /> These i ude more stringent Icak detection and pmvenfion mquiremears,engineering certifications of tank integrity,and financial assurances for <br /> cl at accidental releases.It is lawful to send used oil to out-of-stare facilities that comply only with federal used oil management standards <br /> d.tioi Ih mo kittgenl tequircments.This notification is for information purposes only. <br /> a <br />