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WORK ORD SERVICE AGREEMENT <br /> J Evergreen Enviamental ServicesN� 3 g 5 6 2 Q <br /> J/ dedicated to the protection of the environment /7 x-/1 <br /> To schedule a pickup, call Send payment to: Sales Order #(V f <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 Date: 123 • "z�7 <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> N NAME E <br /> ADDRESS STATE Z���• CITY STATE ZIP CO.PH NE NO. OFH,E NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Rod, on-RCRA Hazardous Lubricating CA221 WA16uid Industrial CA221ve An ifrte Non-RCRA H--N CA134 <br /> buuiae Liquid,N.O.S.NA CAi minalal with halar,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal <br /> Wash Out <br /> Each <br /> Drained Used Oil Filters Drum <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum <br /> Empty Drums <br /> Drum <br /> Transportation Hrs. <br /> Non Hazardous Voter Gal <br /> Glycol Bulk 50150 Gal <br /> Glycol But Cone, Gal. <br /> TEST: Clor D Tech 4000.�Zcjciippm ❑Clor D Tech 1000 Pass❑Fail ❑ Halogen DetectodFlame Test ❑P s ❑Fail .•�` <br /> Field Service Work Description: Total Char es <br /> Other: <br /> Other. <br /> Vacuum rvices Time <br /> Out of and On Site Off Site_Off Load Start Off Load End Retum to Y 8„�' �• �. <br /> TS Consolidated Manifest <br /> Evergreen Oil,Inc. Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ AJS Filter ❑ <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Indusuy,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> Evergreen Env. c. Evergreen Env.Svc. ❑ CFR 11CFR Greenleaf Env.Svc. <br /> 16604 S.San P 745 A West Betteravia 944 E.Situation Ave. 33210 Western 3474 Toyon Circle <br /> Carson,CA 9 46 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD98169 0 CAD982446858 CAL000110021 CAL000091507 CALO(IU214411 <br /> Source: Collection Station Ll Government Generator 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 /> generator to be economically practicable. <br /> ❑Marine ❑ Agricultural ❑ Industrial <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 /> Retain sample # 11, C 3 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 /> se include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for <br /> l ure 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 /> not these more stringent requirements. This notification is for information purposes only. <br />