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WORK ORDEVERVICE AGREEMENT <br /> 0261 - <br /> Evergreen Environmental Services NO- 390242 <br /> dedicated to the protection of the environment <br /> ..// To schedule a pickup, call Send payment to. Sales Order.#L,"cx�L 1,=,-? <br /> 800-596-9455 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 P.O. BOX 30517 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles, CA 90030-0517 Dater <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NArZNAME 'CASH❑CHECK❑ <br /> - .11416040 #. <br /> DRESS. ADD S CUT MER,�ODE NO. <br /> to 7 1S$ la <br /> CI Y STATE ZIP CO. CI Y STATE ZIP CO. PO# <br /> u a. <br /> HONE NO. PHONE NO. PROFILE NO. I CUSTOMER EPA H)NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used ail,Non-RCRA Hazardous Lubricating CA22 a K f Q Gal. <br /> Waste,Liquid Industrial CA221 Gal. �Jr� <br /> Used Automotive AniUmew,Non-RCRA Hazardous CA 134 Gal. 7(.rte <br /> Wastc Liquid _ <br /> RQ Waw Comhusti6le Liquid,N.O.S.NA' CA221 Gal <br /> 1943]n Oil contemiaatcd wish halo cus Fd01lNOn2 <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Drained Used Oil Filters Drum <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum <br /> Empty Drums Drum <br /> Transportation H's. <br /> Non Hazardous W er Gal. <br /> Glycol Bulk 50150 Gal. <br /> Glycol Bul Conc. Gal. <br /> TEST: Clor D Tech 4000_L-10�pm ❑Clot-D Tech 1000 ass❑Fail ❑ Halogen Detector/Marne Test ass ❑Fail -Z;r,,-r* <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: Q L+7, <br /> Vacuum Se ices Time <br /> Out of Y d On Site Off Site Off Load Start Off Load End-!AM- <br /> to Yard <br /> TS Consolidated Manifest <br /> Evergreen Oil,Inc. Evergreen Env.Svc. Evergreen Env.Svc. AJS Filter <br /> 6880 Stntth Ave. ❑ Road 30B ❑ 4139 N.Valentine 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> Evergreen Env.Svc Evergreen Fnv.Svc. CFR CFR Greenleaf Env.Svc. <br /> 16604 S.San Pe 745 A West Betteravia 944 E.5lauson Ave. 33210 Western 3474 Toyon Circle <br /> Carson,CA 907 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD9816964A CAD982446858 CAL000110021 CAL000091507 CAL00021441, <br /> 01 Generator certifies that it has established a program to reduce the volume or <br /> Source: A Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify that I have read,and have the authority to <br /> bind the above listed itenerator to the terms on the reverse <br /> Retain sample # 4, 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 management of used oil, but that is not required to <br /> comply with the more stringent requirements applicable to hazardous waste management facilities. California facilities that handle or process used <br /> oil required to meet those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements. <br /> The include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for <br /> clo a 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 /> an of these more stringent requirements. This notification is for information purposes only. 1 <br />