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J WORK ORDEiti,iERVICE AGREEMENT <br /> Evergreen Environmental Services NO- 463454 <br /> Jdeditnred In der prorecdon of she cuvir'onulenr <br /> To schedule a pickup, call Send payment to: Sales Order# <br /> 800-596-9455 Evergreen Oil. Inc. <br /> 6680 Smith Ave.,Newark,CA EPA#CAD982413262 P.O. BOX 30517 1#� <br /> 16540 S.San Pedro St..Carson•CA EPA#CAD962410262 Los Angeles. CA 00030-0517 Datc: <br /> GENERATORIJOB LOCATION BILLING INFORMATION <br /> NA,tE NAME CASH ❑CHECK❑ <br /> DDRES$ ADDRESS CUSTOMER CODE NO. <br /> tc . Z <br /> CI STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> HONE NO. PHONE NO. PROFILE NO. CL'STORIER EPA ID NO. <br /> ( ) <br /> PRODUCT WASTE MANIFEST =UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil.Non.RCRA Haiallous I-uhricating CA2 Coll- <br /> Waste,Liquid Industrial CA221 Gal. <br /> C A';T <br /> l..AMar...e.N -RCRA CA 134 G61. <br /> 1FIIj ]9s1m mHwuiMMI}p <br /> Gal. <br /> Oil&Water.Non-RCR.A Hazardous Waste Liquid CA221 Cul. <br /> Waste Solids and Sludges Col. <br /> Wash Out Each ' <br /> Drained Used Oil Filters Drum <br /> Nun•RCRA Hazardous Waste Solids(oily debris) CA223 Drum <br /> Empy Drains Drum <br /> Trmuponation Hrs. <br /> Non Hazardous Water Gal. <br /> Glycol Bulk 50/5O Gal. <br /> Glycol Bul' Cone. Gal. <br /> PEST: Clor D Toch 4IXkl`Z,=ppm ❑Clor D Tech 1000 Pass❑Fail ❑ Halogen Detector/Flunw lest Puss ❑ Fail <br /> Field Service Work Descriptio,: Total Charges <br /> Other: <br /> Other: <br /> Vacuum Ser,ices Time <br /> Out of "amt On Site Off Site On Load Start Ofl'Load End Return t .W <br /> 1Isr MCcinsolidated Manifest <br /> l_"roan Oil.Inc. 1:1Ewrgmen Enc.Sec. El4131) <br /> Enc.Sec. O A1S Filter ❑ <br /> GRSII Smith AYY. Road 30B 3139 N. Valentine 15131 Clark Ave. - <br /> Ncxark.CA 94560 Daeis.CA 95h16 Fresno,CA 93717 Indimq,CA 91745 <br /> C'.AD980887319 C'AD9S2446874 CAD992446R82 CAD00(0)7432 <br /> Ecer-•rcen Enc.Sa-. 0 E,ocwen Flo.Svc. CFR CFR Greenleaf Em.SIC. <br /> 16604 S.San P n 745 A\1'oi Beneiacin ❑ 944r. Slamon Am. 1:1 33710 Wcstcm 3373 Toxon Circle <br /> Camx1.CAc 446 Snnia Xb,ia.CA 0345! 1 ns Angdrs.CA Whl I I Inion Cio.CA 44i87 Valley Wro s.CA 9535] <br /> CADS1 0 CAD982446858 CAI,00(1110(121 C'ALOW091307 CALINn_14111 <br /> �1 Generator verities that it has established is juog and to reduce the Intense or <br /> Source: 2f Collection Station :3 Government quantity d:toxicity of the hazankms wast(to the deyrec determined h7 <br /> ❑ Marine ❑ Agricultural l7 Industrial Iencnnor to I>L ccononlicaliy practicable. <br /> 1 hereby cerlifl, that 1 have read and have the aothorlty to <br /> Retain sample # �! bind the above listed generator to the terms on the reverse <br /> side of this form. <br /> IiVIPOWFANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br /> Per California Health and Safety Code Station 2525119, F\cmcce hcicbp ackius customer Ihm cu.wnler's shipment of uIed oil may be <br /> transported to it laciliq• that is required to comply with federal regulations applicable to nlanuecnlenl of used oil. but thin i, not required to <br /> Comply with the mire sitingcro requirements applicable to hazardous \vasty maoaccment facilities. California facilities that handle or PrOCCss used <br /> oil We Irquirtd to InCel thOse mare stringent mquirenn^ntS, and some out-ol-slate I"Cilities that process used oil also meet those requirements. <br /> T .. include more .dringent leak detection and pmyention reqm <br /> uireents. n1,•inecri Use Ceni licatiuus ol'tmlk integi ity. and financial assurances lilr <br /> C esu V and accidental releases. it Io lawtul lu still used oil to out-ul'-slate ILCililics that mlnPlc unh With fcder:d used oil management Standards <br /> r Id 11t these molt strineeu ryuirenlent.. This notification is lininloinizi ion purposes only. <br /> 7� � <br /> 2.��$_. cSC.ry� <br /> Of \cr Sign.111H P:int \�. 1 R,nn: = f):u� 7encr;uo�•. Smndunr I'llm \an3e <br /> 9 -d ia80ZLL4602 YIN CH31`4/1,111 H02uW NNIS ds0 :21 80 sa des <br />