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WORK ORDER/SERVICEAUMEt VISN It <br /> Evergreen Envirenental Services N_ 607088 <br /> dedicated to the protectrsn of the environment p , <br /> To schedule a pickup,call Send payment to: Sales Order# <br /> 800-596-9455 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: <br /> GENERATOR/JOB LOCATION BILLING <br /> AME G INFORMATION CASH Ej CHECK E] <br /> 1 ADDRESS CUSTOMER CODE NO. <br /> A DRESS n a C;> <br /> CITY STATE ZIP CO. CTTY STATE ZIP CO. PO# <br /> PHO NO. \a., PHONE NO. PROFILE NO. CUSTOMER EPANO. 2 <br /> 3 ( I c✓n <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA22 74iY Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> UsWAusomoarc Artfte .Non-RCRAHm,,J"s CA134 Gal. <br /> Wask Li uitl CA221 <br /> RQ Wass.Combuatlbm Liquid N.O.S.NA X002221 Gal. <br /> 1993 m Oil conwrri d with ham eas <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA223 Gal. <br /> Gal. <br /> Non Hazardous Water <br /> Gal. <br /> Waste Solids and Sludges <br /> Each <br /> Wash Out <br /> Pressure Washer/Steam Cleaner Day <br /> Hn. <br /> Transportation <br /> % <br /> Fuel Surcharge <br /> Glycol Bulk 50/ /Specify Product Gal. <br /> Glycol Bulk onc./Specify Product Gal. <br /> TEST: Clor D Tech 4000 __. pm ❑Clor D Tech 1000 ass ❑Fail <br /> Total Charges <br /> Retain sample# <br /> Re uired C. <br /> Field Service Work Description: <br /> Other: <br /> Other: <br /> TS Consolidated Manifest DRIVER C CKLIST <br /> Evergreen Oil,Inc. Evergmen oil,Inc.-DavisEvergreen Oil,Inc.-Fresno ❑ Time In Time Out <br /> 6880 Smith Ave. Road 30B ❑ 4139 N.Valentine p Tank/Drum Properly Labeled <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 <br /> CAD980887418 CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked <br /> Evergreen Env.Svc. ❑ Ewgreat0il,t Betteavia <br /> ❑ House Keeping-Tank/Drum Clean <br /> 16604 S.San Per 745 A Wes[Betteravia ❑ Other Services Checked: ❑ Oil, ❑ Filters/Drums, 0 Antifreeze <br /> Carson,CA 9074 Santa Maria,CA 93454 ❑ Called in other services needed ❑Oil, ❑ Filters/Drums,❑Antifreeze <br /> CAD98169642 CAD982446858 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station ❑Government quantity&toxicity of he hazy dous waste to he 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 generator 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 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 son*out-of-state facilities that process used oil also meet those requirements. <br /> Inver <br /> iclude more stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> 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 /> these more stringent requirements.This notification is for information purposes only. <br /> lgnature Print Name Route# Date eneratdr3 Signature Print Name Date <br /> White Coo <br /> Copy-Pink&Yellow Copy=Office Use-Green Copy=Attach to manifest-Golden Copv=Driver Coov <br />