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WORK ORD RVICE AGREEMENT <br /> Evergreen EnvilrUnental Services <br /> dedicated to the pwrection of the environmNo + <br /> 62 <br /> '�_4 ent <br /> To schedule a pickup,call Send payment to: Sales Order# (SOL CXl t j <br /> 800-596-9455 Evergreen oil,Inc. <br /> 6880 Smith Ave.,Newark CA EPA#CAD982413262 DepL LA 23234 f <br /> 16540 S.Saa PedroSr,Carson,CA EPA#CAD9824U262 Pasadena,CA 91185-3234 Date:_ — - <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NAME ' <br /> S <br /> CASH Q CHECK IT <br /> X. <br /> � A o« er�l eSl� ,,,c COCA CtXeH/e1N ,c3r.1 . � <br /> ADDRESSADDRESS <br /> CUSTOMER CODE NO. <br /> ILII0 EL GiS( �I SSC- 0-0 toyStNwt Awy 601, WIC <br /> UFFY STATES-f`Z)wj t, CP `�T zorco. Cl n o 4e STAT (4�N 2 CO. Tb-#— <br /> Not ` �l) PHONE NO. PROFILE NO. O <br /> C h ID O. <br /> f c 1P� LY�i <br /> 7Y6) <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Nwl-RCRA Hazardous Lubricating CA221 Gal- <br /> Waste,Liquid Industrial CA221 C,ral, <br /> CA134 Gal. <br /> aQVMeCnNvmbb L'puW.ND9.NA CR31 <br /> r993m Oil ainNmi,wN wip Mb FlgI/FOm Gal. <br /> Oil&Wow,Non-RCRA HaraMals Waste Liquid - CA223 C770�94gK �� Gal. LC' <br /> Non Hazardous Water Gal. <br /> Warn Solids and Sludges <br /> Wash Out Each. <br /> a Pressure WashcdSteam Cleaner Day <br /> a <br /> .< 7tansportarim tin. L <br /> Fuel Surcharge % <br /> Glycol Bulk 50150ISpecify Product Gaal. <br /> Glycol Bulk Conc,/Speeify Product Gal. <br /> TEST.❑Clor D Tech 40W---.ppm ClorD Tech 1000 E]Fail <br /> Retain sample# Total Charges <br /> Re aired <br /> F�dServicaWork Description: ,+}+ t!! i� <br /> Other: O / <br /> TSDF ❑ Consolidated Manifest DRIVER CHECKLIST <br /> ET= <br /> Oil,Inc. ❑ Eve gieen0iijac.-Davis <br /> ❑Evergreen 00,Inc.-Fresno O Time In 'irate Out <br /> 4J 6880 Smith Ave. Road 30B 4139 N.Valentine <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 ❑Tank/Drum Properly Labeled <br /> CAD%08874t8 CAD982446874 CAD982446882 O Accumulation Stan Dale Marked <br /> ❑ Evervorcen Fs v.Svc. ❑ Frog,®r($frc,-SaoaMae❑ ❑House Keeping-Taolo'Dnlm Clean <br /> 166045.San Pedro 745 A Wes[Beaerovia ❑Other Services Checked:G 00, O Filters/Drums,O Antifreeze <br /> Carson,CA 90746 Santa Maria,CA 93454 .�:'- <br /> CAD981696420 CAD992446858 ❑Called in other services needed Oil,.[] MherslD uns,[3Andfr <br /> Source: ❑Collection Station L)Government Grnem or ce tries that it has established a program to reduce the volume di<=' <br /> quantity&toxicity of the hazardous waste to the degme detemdned by <br /> ❑Marine ❑ Agricultural ❑ Industrial generatmmbeemnomically practicable. <br /> I hereby certify that I have read and have the authority to <br /> bind the above listCdgenerator 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 customers shipment of used oil may be <br /> transported to a facility that is required to comply with federal regulations applicable to management of used oil,but that is not reggired to <br /> --- --mmptywitlrthe more stringent tequtrenlenrs-app icaMe to-haiaidous wuue miivagemeiii fhEi ties.California facilities 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 mare stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> closure and accidental releases.It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> and not these more stringent requirements.This notification is for information purposes only. <br /> Q ca.j r /' .EJ <br /> f �C SSS .,e� <br /> Dever Signature Print Name Route# Date Generator's Signature Punt Name Date <br />