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WORK ORDE"3ERVICF. AGREEMENT <br /> Evergreen Environmental Services N° 454865 <br /> �/ dedhoiefl to the protection of dle en rironmetrt <br /> /0 To schedule a pickup, call Send payment to: Sales Order# <br /> 800-596-9455 Evergreen Oil. Inc. <br /> 6880 Smdh Ave..Newark,CA EPAII CAD982413262 P.O. BOX 30517 <br /> 16540 S.San Pedro St.,Carson,CA EPAN CAD982413262 Los Angeles. CA 90030-0.517 Date: <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> VA? �N "'Alit tt ASH ❑CHECK❑ <br /> hillss 3 4U� ne e;f C O�IFR rZo. <br /> r" STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> CQ <br /> ONE ' PHONE NO. PROFILE NO. T MER EY:1 IU..\C <br /> / f <br /> PRODUC'1. WASTE. MANIFEST QUANTITY UMTS PRICE AMOUNT <br /> CODE. NUMBER <br /> Used oil.Nnn-RCR.A Hazardous Lubricating CA22P4 Gal. z <br /> Waste.Liquid Industrial CA221 Gal. <br /> tlnU Auxmmee Tmnno:e.N.m-xfN\Ib:an6u. CA 134 Gal. <br /> w.w L' nJ <br /> x0 wNe a„mnw�nr.LiuuiJ.I+.ns.rse NNII e'Ah,I p <br /> 3 3 Gal. <br /> Iw.r 111 rIAI mimmiruhJ xvrb M1ah era <br /> Oil&Water.Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Drained Used Oil filter, Dona <br /> Non-RCRA Hmnlous Waste Solids(oily debris) CA223 Drum <br /> Empty Drums Drum <br /> Tr mcpinurion lies. <br /> Non Ilarardurs Wafer Gal. <br /> Ghent Bull: 50/50 Gal. <br /> Glycal BuIA Core. Gal. <br /> TEST:❑ Clor D Tech 1000 ppm ❑Clor D Tech 1000E]Pass❑Fail ❑ Halogen Dciectoa Flange Test ❑Poes ❑Fail <br /> Field Semcc Wort Descriptio,: Total Charges <br /> Other: <br /> OIMr: /7 <br /> Vacumn Services Tir <br /> Our ul'YarJ On site OIf Site On [.,hall Stun OI'f Load End Itelnm to Yard /V/I"e✓�� <br /> S '111 Consolidated Manifest <br /> E\'trgrcen Oil.Inc. Lvcrga}.n 17 .Svc. Evcrgrcen Enc.Svc. AJS Filter <br /> 6';11 Smith Ave. ❑ Roar f 3 ❑ 4139 N.Valentine 15131 Clark Ave. <br /> Newark. 'A 9J_560 D CA 956I6 Fresno.CA 93732 induurv.CA 91745 <br /> CAIK)803S7J 13 D93344(374 C.AU`)324J6332 ('ADlN1lN197J32 <br /> ❑ Lverer lin'.Svc. Ewna,n Enc.Svc CFR CFR Greenleaf Env.Svc. <br /> I(ddN S.San Po"I 715 A lycsl BCuentvia ❑944 E.Slauson Ayc. ❑ 3.5210 Wcx(cm 3474 lbynn Circle <br /> Carson.CA 907 Sema Mark,.CA 93454 Los Anoelcs.CA 90Ol I Union City.CA 94537 Valley Springs.CA 95351 <br /> ('.AD9;I(PXvi' C.%>);'_JJ635s CA11100110021 CAL000091507 CAL0002I4411 <br /> Genet for certifies that it has e,lnbli,hed it program it,reduce the rulunw ur <br /> Source: Collection Station GuI—vrernrnent quamiry .@ Imiuity ul'the h;uartlnus waste m the degree detenuincJ by <br /> ❑Marine 01oricultural I_t Industrial "cner:ma to Ix economically prauivahlc. <br /> t hereby certify that 1 have read and have the authority to <br /> a bind the above listed Generator to the terms on the reverse <br /> Retail) sample # side of Ihis form. <br /> IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br /> Per California Health and Safety Code Section 25250.9, Evergreen hereby advises Cusurtuer that customer's shipinem of used oil may be <br /> transported to a facility that i, required m Comply oilh federal re;ulorons applicable to management of used oil. but that is not required to <br /> comply with the more stringent requncinc us applicahle to hazardous \caste nl:ulagen)ent Glcilities. Calillxnia facilities that handle or process used <br /> oil are required to meet those morn strineent requirements. and sonic uul-ul-stua facilities tical process useCI oil also meet those requircnrents. <br /> Th”' inCludC Iln'C sirinecal leak defection tnnl prcenuinn requirema ts. cnpinecrin_cerci firuions of"tank integrity. and financial assurances for <br /> Ch tLk ne ental icleuscs. It is lawful Io send used oil to I-ol- lute tacit itcs That Comply only with Icderal used oil ncmo_Cment sl:uul:nd. <br /> :nn se are tri ernt require oks. TI 's nnlilicalion r inf irlualion purposes only. <br /> ri\rr Sign e Pr m : anx Ruurt ii Daae Gel cralor ,s Sieh:nul." Mini \arae -- Dane <br /> e 'd bBOZLL460Z UIH Oa311,1/14IC UOZUW 1,11>I1S d90 :2I 60 SZ Gies <br />