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Juans Auto Repair 2094634722 p.1 <br /> WORK ORD. 'SERVICE AGREEMENT <br /> Evergreen environmental Services <br /> 20(�ndedicated ru the protection of the rnrrrnnment <br /> fio schedule a pickup,call Send pay,oLn t(/. Sales Order # <br /> S, W JOF.Qulir'COU9lurO-596-9455 Evergreen Oil,Inc. <br /> 6890 F,66&'XA1 •iW".CA EWO CAD982413262 Dept.LA 23234 <br /> I6,&P,§V I Aida ll '+Ln,CA EPA#CAD9824I3262Pasadena,CA 91185-3234Date: <br /> GENERATOR/JOB LOCATION BILLING INFORNWION <br /> NAME CASH❑CHECK❑ <br /> ADDRESS j t CUSTOMER CODE NO. <br /> CITY STATE ZIP CO.! r 7 r F10 <br /> PHONE NO. CUSTOMER EPA ID NO. <br /> V <br /> PRODUCT WASTE AMOUNT <br /> CODE <br /> Used oil,Nnn-RCRA Hazardous Lubricating CA221 Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> L�xd.lutumwivv Antifmve.Non-RCRA H;var,kxs CA134'. �., <br /> RQ%Vwc Cnmlxt%iblc Liquid.N.O.S.NA CA221 <br /> 111)311r(Oil wnwmioatcd with ha nns) Gal. <br /> Oil&Water.Nan-RCRA Hazardous Waste Liquid CA223 Gal. <br /> Non Hazardous Water Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Pressure Washer/Steam Cleaner Day <br /> Transportation Hrs. <br /> Fuel Surcharge ok <br /> Glycol Bulk 50/50/Spec:ify Product Gal. <br /> Glycol Bulk Conic./Specify Product Gal. <br /> TEST:❑Clor D Tech 4000ppm ❑Clor D Tech 10M❑Paas❑ Fail ❑Pass ❑ Fail <br /> T(Xzd Charge~ <br /> Required <br /> Field Service Work Description: <br /> Other: <br /> Other: <br /> TSDF ❑ Consolidated Manifest ------- DRIVER CISE('!e, ^ -- <br /> Evergreen Oil,Inc. Evergreen Oil,Me.-DavisEvergreen Oil,Inc.-Fresno L-1Timv In" ;.. ' Tink:()LI,6880 Smith Ave. ❑ Road 30B F-14139 N.Valentine <br /> Newark,CA 94560 Davis.CA 9,5616 Fresno,CA 93722 ❑'l ani '!�runa!'rulxrly Lah kd <br /> CAD980887418 CAD982446874 CAD982446882 pAc-cumii:aitx:Sim IDat,:l:';ar!,.,'. <br /> ❑ Evergreen T:m,.Svc. Emwcmatb--11mbiN•talia `0 I low"iwi•ni::c 'l"IMU)rtuu Clean <br /> 16604 S.San Pedro 11745 A West Beueravia ❑ ()(';;:rS_r+'icc>C'ho'ked: LI CHL :J Fillc.•s/Drums, ;utili.c r:: <br /> Carson.CA 90746 Santa Maria,CA 93454 <br /> CAD981696420 CAD982446858 LI t'allc,i illlrihar xct'v:r o t dca ❑(?it. i] Fihcrsil>rulm.❑Aiiiil'reela <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station ❑Government quantity 8c toxicity of the hazardous waste to the degree determined by <br /> Marine C] Agricultural J Industrial generator to he economically practicable. <br /> I hereby certify that 1--have read and have the authority to <br /> bind the ahove tilted generator to the terms on the reverse <br /> 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 be <br /> transported to a facility that is required to comply with federal regulations applicable to managetnent of used oil,but that is not required to <br /> comply with the more stringent requirements applicable to hazardous waste management facilities.Califotmia fac;lities that handle or process used <br /> oil are required to meet those more stringent requirements,and some out-of-state facilities that process used oil also meet those requirements. <br /> These include more stringent leak detection and prevention requirements,engineering certifications of tank inteariry,and financial assurances for <br /> closure and accidental releases. [t is lawful to send used oil to out-or-state facilities that comply only with federal used oil managenunt standards <br /> and not these more stringent rrquirentcnts.This notification is for information purposes only. <br /> Driver Signature Print Name Route# Date Generator's Signature Print Narne Date <br /> lr-in l^Coag-Gats o-,ef Copy-rink&YcilCi^! ;,ss Green Ccp,---„!tuc.i ii.ni^17iI^:ii t�^,.::(;;;:1��C�Yj%-�r'.`.�ii.iG;i�• <br />