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�j Evergreen Env#nmental Servic soRx oRnSERVICE AGREEMENT <br /> dedicated to the protection of the environment No <br /> 398095 <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 P.O. BOX 30517 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles,CA 90030-0517 Date: L/-`�•-Q7 <br /> GENERATOR/JOH LOCATION BILLING INFORMATION <br /> N NAME CASH❑ CHECK❑ <br /> ADDRESS _ ADDRESS CU QMER CODE NO. <br /> S <br /> CI STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> zi <br /> ` PHO ENO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> E1110ill <br /> on-RCRA Hazardous Lubricating CA22 Ll'. Gat. `..0 <br /> id Industrial CA221 Gal. <br /> Andfrtve,Non-RCRA Rem us CA134 <br /> Gal. <br /> uvlble Liquid,N.O.S.NA pAyy <br /> an..,M wjN halo, roovRooz Gater,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 <br /> Hrs. <br /> Non Hazardous W Gal <br /> Glycal Bulk 50/50 Gal. <br /> Glycol BuIV Conc. Gal. <br /> TEST:. Clm D Tech"*ZqQ pm ❑Clor D Tech 1000 Pass ❑Fail ❑ Halogen Detector/Flame Test ❑Pass ❑Fail <br /> rlA <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other, <br /> Vacuum Services Time <br /> r <br /> Out of ard On Site Off Site_Off Load Start Off Load End-Return Yard <br /> TS Consolidated Manifest <br /> Evergreen Oil,Inc. ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. 1:1AJS Filter ❑ <br /> 6880 Smith Ave. Road 30B. 4139 N.Valentine 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Industry,CA 91745 <br /> CAD9808874t8 CAD982446874 CAD982446882 CAD000097432 <br /> Ever en Env.Svc Evergreen Env.Svc. CFR ❑ CFR Greenleaf Env.Svc. <br /> 16604 A S.San Pedp- El 745 AWest Betteravia 944 E.Slauson Ave. 33210 Western 3474 Tryon Circle <br /> Carson,CA 90 6 Santa Maria,CA,93454 Los Angeles,CA 90011- Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696K CAD91ii2446858 CALDW110021 CALM91507 CAL000214411 <br /> Source: Collection Station ❑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 /> ❑Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> Retain sample # bind the above listed generator to the terms on the reverse <br /> c� 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 /> These include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for <br /> sure and accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil agement standards <br /> not these more stringent requirements. This notification is for information purposes o�nly. n\1/ <br /> V Hyl' fl� 4�/ <br /> ..or 6,..,nb..o ♦ AT.....� n,...a,. u r_._ / n_.-___._�_ ne_.__�__. ., ., ,� <br />