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WORK ORD SERVICE AGREEMENT <br /> Evergreen Envenmental Services N° 404882 <br /> dedicated to the protection of the environment ,,� )) <br /> To schedule a pickup, wl Send payment to: Sales Order#w�122t f`e <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:(2` 1-IZ7 <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> Mohr NAME CASH❑CHECK❑ <br /> ADDRESS _ ADDRESS CU OMER CODE NO. <br /> s <br /> C Y STATE ZIP CO. CITY STATE ZH' CO. PO# <br /> CIO <br /> MUNE NO. PHONE NO. PROFILE NO. CUSTOMER EPA m NO. <br /> tto4) L — ( eS4.LS1x+ 7L/ <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Used oil,Non-RCRA Hazardous Lubricating CA22 Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Waste Limed iv Awifrteu,Non-RCRA Hau . CA134 Gal <br /> RQ Wastt Combustible Liquid,N.O.S.NA CA231 <br /> 1993 III Oil canumina�M wiN halo n FIXII/Fn02 Gal. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal <br /> Wash Out Each <br /> Drained Used Oil Filters Drum <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Dram <br /> Empty Drums <br /> Drum <br /> Transportation Hrs. <br /> Non Hazardous W r Gal <br /> Glycol Bulk 50/50 Gal <br /> Glycol But Cone. Gal <br /> TEST: Clor D Tech 4000pro ❑Clor D Tech 1000 Pass ❑Fail ❑ Halogen Detector/Flame Test Pass ❑Fail .T <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum Se s Time <br /> Out of Y On Site Off Site Off Load Start Off Load End etiun to Yard <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 Industry,CA 91145 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen Env.Svc ❑ Evergreen Env.Svc. ❑ CFR CFR Greenleaf Env.Svc. <br /> 16604 S.San P 745 A West Betteravia 944 E.Slauson Ave. 1:1 33210 Western 3474 Toyon Circle <br /> Carson,CA 90 6 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD98169 CAD982446858 CALM110021 CAL000091507 CAL000214411 <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 detemtined 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 /> Retain sample # G. 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 A c required to meet those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements. <br /> T include more stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> cls a 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 /> d of these more stringent requirements. This notification is for information purposes only. <br /> In---------+_ n:__------- ra_e_. XT-_- .._._ <br />