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J WORK ORDEVERVICE AGREEMENT <br /> Evergreen Envirollnental Services N° 549410 <br /> dedicated to the protection of the envintwnent <br /> To schedule a pickup, call Send payment to: Sales Order# <br /> 800-596-9455 Evergreen Oil, Inc. <br /> r,sau Sandi Ave.,Newark.CA I-PA#CAD98241326'_ Dept. LA 23234 <br /> t 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: <br /> GENERATORMOB LOCATION BILLING INFORMATION <br /> NAME NAME CASHK <br /> i-> # <br /> ADDRESS ADDRESS CUST IER CODE NO. <br /> CITY STATE ZIP 'O. CITY STATE ZIP CO. PO# <br /> R <br /> P O E PHONE NO. PROFILE NO. CUSTOMER EPA ID N <br /> 1 ti ( ) <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE .UIOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Autmmnive Anifveze,Non$CRA M,.11onv CA 134 Gal. <br /> Wave Li aid <br /> RQ Wave OmWstible Liquid.N.O.S.NA CA221 Gal <br /> -1 v93 In(oil ronw.maed wi1b halo en FOnt/ft), r <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA22. - QC� Gal. / ill, <br /> Non Hazardous Water Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Pressure Washer/Steam Cleaner Day <br /> Transportation Hrs. <br /> Fuel Surcharge <br /> Glycol Bulk 50/5 pecify Product Gal. <br /> Glycol Bulk a/Specify Product Gal. <br /> TEST: Clor D Tech 4000—ppm ❑Clor D Tech 1000❑Pass❑ Fail [:]Pass ❑ Fail <br /> Retain sample# Total Charges <br /> Required C. L <br /> Field Service Work Description: <br /> Other: <br /> Other: <br /> rte.. <br /> TSD ❑ Consolidated Manifest DRIVER CHECKLIST <br /> Evergreen Oil,Inc. F-1 Evergreen Oil,Inc.-Davis❑ Evergreen Oil.Inc.-Fresno ❑ Time In Time Out <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 ❑ Tank/Drum Properly Labeled <br /> CAD980887418 / CAD982446874 CAD982446882 ❑ Accumulation Stan Dare Marked <br /> ❑ Evergreen Env.Svc/ ❑ EseipmlQ4lrc.-SwaMau❑ ❑ House Keeping-Tank/Drum Clean <br /> 16604 5 San Ped 6 745 A West Betteravia ❑ Other Services Checked: O Oil, OFilters/Drums, O Antifreeze <br /> Carson,CA 907 Santa Maria,CA 93454 <br /> CAD9816964 CAD982446858 10 Called in mhrr services needed C]Oil, ❑ Fil[el:c/Drums,❑Antifreeze <br /> Generator el li tics Ihst it ham established a program to reduce the volume or <br /> Source: 2rCollection Station ❑Government quantity&toxicity of the hvmduus waste to the degree determined by <br /> ❑ Marine ❑ Agricultural ❑ Industrial generator to be econumiedly practicable. <br /> 1 hereby certify that 1 have read and have the authority to <br /> bind the above listed Venerator to the terms on the reverse <br /> side of this form. <br /> INIPORTANT 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 ail,hot that is not required to <br /> comply with the more stringent requirements applicable to haiaidOUS waste management ILcilities. California fac' ities I t handle or process used <br /> it ure re(limcd to meet those more stringent requirements,and some out-of-state facilities that process used Oil 1 0 ice ose requirentenis. <br /> 1 ce include more strineent leak detection and prevention requirements,engineering certifications of utak int g i .1 ficial assurances for <br /> e1 s re and uccidenl:d rcicuocs. It N lawful to send used Oil to out-of-state facilities that conlldy ani i of 1 I m ta,mocnl standards <br /> ;w 1 a Ihcsc more stringer �cyuircmenls.This nuliticatiun is liar inforniatiion purposes Only. <br /> � e*i l \ <br /> Dr i er Signature Print Name R011te # Date eneratol's Si tre rml Name Date <br />