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J Evergreen Environm&al Services Wo*Order <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send Payment to: dill of Lading W00336891 <br /> 800-596-9455 Evergreen Oil Inc Customer C00045 <br /> or 510-795-4400 Dept.of LA 23234 <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Pasadena,CA 91185-3234 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 <br /> Pickup Location: Bill To: <br /> COCA COLA REFRESHMENTSUSAINC COCACOLAREFRESHMENTS USAINC <br /> 1467 EL FINAL DR 15M OLD SAYSHORE HWY <br /> CC....4437 ATTN FLEET DEPT <br /> STOCKTON CA 95205 SAN JOSE CA 95112 <br /> Contact: <br /> NOTE M)513-70117 EaL11000 <br /> CUST NO. EPA NO. TERMS PURCHASE ORDER NUMBER - TERRITORY <br /> pe�en sl� IN MM 97,93.DATE BOE NO. illgroup OIL ROUTE PROFILE PROFILE PRI'08 BY <br /> Reg. Pickup Item Description Manifest No. Unit Price Amount <br /> e Na..N v0 -item HilmoO6 W alYe 73OIIID ( �7QI2 ATiJ foss (eSA.o <br /> 7N.M 0 VACUUM SUnS IYUCHil 9MOHS � <br /> st.�s�a 5 <br /> WmMY 7LaOR/IRMPocxlss0111' $75.00 37 5.0 <br /> �•MILLSHOUT Pec <br /> f15D.00 <br /> TSDF ❑Consolidated Manifest DRIVER CHECKLIST <br /> Evergreen Oil,lnc. ❑Evergreen Oil,lac.-Davis 1:1Evergreen Oil,Inc.-Fresno❑ ❑nme m tare W <br /> 6880 Smith Ave. Road 30B 4139 N.valentine OT. .maoaart,ut4 <br /> Newark,CA 94560 Davis,CA 95616 Fream,CA 93722 �xormmaeonaan wceatmka <br /> CAD980887418 CAD982446874 CAD982446882 oxovse respre7anaorcen ecesn - <br /> ❑EwflimenEnv.Svc.❑Evergreen Oil,Inc-Same Maria SA Recycling ❑o4arseroves arenaxpatoanemmnms,pmiurccem <br /> 16604 San Pedro 745 A West Bettemvia 1:133210Wes1em ❑cau4uou.raermv w4Om,onievpiiurs,onnaM1eexe k rm^; x+s sn <br /> Carson,CA 90746 Santa Maria,CA 93454 Union City,CA 94587 <br /> CAD981696420 CAD982446858 CAL000344530 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: ❑Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑Marine ❑Agricultural ❑ Indnstrlal generator to be economically practicable. <br /> I hereby certify that I have read and have the authority <br /> W bind the above listed generator to the terms on the <br /> Retain Sample# reverse 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 transported to a facility <br /> 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 requirements <br /> applicable to hazardous waste management facilities.California facilities that handle or process used oil are required to meet those more stringent requirements,and <br /> some out-of-state facilities that process used oil also meet those requirements.These include more stringent leak detection andpprevention requirements,engineering <br /> certifications of tank integrity,and financial assurances for closure and accidental releases.It is lawful to send used oil to out-of-state facilities that comply only <br /> with federal used oil management standards and not these more stringent requirements.This notification is for information purposes only. <br /> briver Signature Print Name Route# ! Date Generator's Sianature Print Namn nato <br />