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Sep. ?_2 10 12: 21p Eng tared Automation (209) 368-0645 p. 7 <br /> • WORK ORDASERVICE AGREEMENT <br /> Evergreen Environmental Services <br /> 4V N-0 591504 <br /> dedirmzd to the ptr,lcelion gf1he eurinanueut <br /> To schedule a pickup,call Send payment to: Sales Order# <br /> 800-596-9455 Evcrgreen Oil,Inc. <br /> 6990 Smitb Ave..Nau•;uk.CA EPA#CAD9a2413262 Dept.LA 23234 p <br /> 16s4u S.S:m Pedro st.,Curzon.CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: <br /> GENERATORIJOB LOCATION BILLING INFORMATION <br /> NAME NAME <br /> C6P4.7 CASH F]CHECK❑ <br /> ADDRFa;' ADDRESS UT M$R�CODE NO. <br /> �'� A), f<0N/J-r'j�*c CAt7f <br /> CITV STATIi 'LIP Co. CITY STATE ZIP Co. PO# <br /> AA) P.- cIq �a <br /> PHONE NO. PHONE NO. PROFILE NO. COSTO IER FPA ID NO. <br /> ( , � -334-raj ( , e a,�c, <br /> PRODUCT WASTE MANIFF.S'P <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Q - 6 Gal <br /> Waste,Liquid Industrial CA221 <br /> al. <br /> `µuYgntomnn.•n,numm. acaA nr„ai,,,,. CA 134 GnI. <br /> H9 w'atc CnmMu,inle Liynid.NA.S.NA egnl <br /> IY13111 ala emtamtnalavl unM1 M1al,•vn•1 F(pli12 Gill. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA223 Gal. <br /> Non Haat dour Water Gul. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Pressure Washer/Steam Cleaner <br /> Day <br /> Transportation Hrs. <br /> Fuel Surcharge % <br /> Glycol Bulk 50/50/SPceify Product Gal <br /> Glycol Bulk Conc./Specify Product Gal. <br /> TEST.❑Clor D Tech 4000—ppm for D Tech 1000 ❑Pass ❑Fail �' G <br /> Retain sample# oral Char es <br /> Required 'rte <br /> Field Service Work Description: <br /> Other. <br /> Other: <br /> TSDF Consolidated Manifest D ER CHECKLIST <br /> Evergreen Oil.Inc. seween oil.(rte.-Davis Evergreen Oil,Inc.-Fresnotime h l��d Time OutZ6880 Smith Ave. LLLL--''�iiiillRRiioad 30B 4139 N.VulemineNewark,CA 94560 Davis.CA 95616 Fresno.CA 93722 nk/Drum Properly Labeled <br /> CAD980887418 CAD982446874 CAD982446RR2 ccumulation Start Date Marked '14 c1 <br /> Evergrten Env.Svc. 11EtegsunlOil.lrc.-SanuMvu� 0 House Keeping-Tank/Drinu Clean <br /> 16603 5.Sun Vedro 745 A West Bcucravia 0 Other Services Checked: 0 Oil, 0 Fillers/Dmms,0 Antifreeze <br /> Carson.CA 90746 Santa Maria,CA 93454 <br /> CAD9816 0 CA091t2446958 0 Called in other services needed E3 Oil, 0 Filters/Dmnis,El Antifreeze <br /> SOUI'Ce: olleetion Station ❑Goveminent Gc1lundur certifies that it has established a program to reduce the volume or <br /> quantity&toxicity of the hazardous waste to the degree determined by <br /> Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> 1 herehv t•ertifv that 1 have mad and have the authority t( <br /> hind the above listed Pcnerator to the terms on the revers <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 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 are required to meet those more stringent requirements,and some out-of-state facilities That process used oil also meet those requirements. <br /> The4hl�t'.eC <br /> tringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> closal releases.It is lawful to send used oil to out-or-slate facilities that comply only with federal used oil management standards <br /> andtri gent requirements.This notification is for information purposes only. e C�"5,Aell;Drint Name Route# Date Genera c's Signature Print Name Date <br /> Copy=Customer Copy-Pink&Yellow Copy=Office Use-Green Copy=Attach to manifest-Golden Copy Copy <br />