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WORK ORDESERVICE AGREEMENT <br /> �j Evergreen Enviiomental Services No- 3 0 7 4 0 <br /> -�/ dedicated to the protection of the environment , <br /> r To schedule a pickup, call Send payment to: Sales Or ett r # _-_1y �! (Itx„A <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#CA0982413262 Los Angeles,CA 90030-0517 Date: <br /> GEN TORUOIB LOCATION BILLINGF4WORMATION <br /> NA NA teA�eCASH❑CHECK❑ <br /> S� ADDRESS (�/v-7 DE O. <br /> CI STATE CITY I /ff-I O# <br /> 14 <br /> P N O. / 1n)— <br /> / j�// PHONE NO. P OFILE 40.. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Amommive Andfrt .Non-RL Hu ws <br /> Ut a me CA 134 Gal. <br /> RQWane Combustible Liquid N.O.S.NA CA221 <br /> i99e ill roil conavv wlm MO FOOEIF002 Gal. <br /> Oil d 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 Drum .., <br /> Empty Drums Drum <br /> Transportation HIS. <br /> Non Hazardous Water Gal. <br /> Glycol Bulk 50150 Gal. <br /> Glycol Bulk Cone. Gal. <br /> TEST:❑ Clor D Tech 40W_ppm ❑Clot D Tech 1000E]Pass❑Fail ❑ Halogen Detector/Flame Test ❑Pass ❑ Fail <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum Services Time <br /> Ou[of Yard On Site Off Site Off Load Start Off Load End Return to Yard <br /> TSDF ❑ Consolidated Manifest <br /> Ever❑ lter <br /> 6880 Smith Ave. ❑ RoaEvergreen <br /> OB Env.Svc. ❑ Ever4139 Nom.Valentinen Env. 15131 <br /> ❑ 5131JS Clark Ave. ❑ <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ CFR CFR ❑ Greenleaf Env.Svc. <br /> 16604 S. San Pedro 745 A West Beaemvia 944 E.Slauson Av 33210 Westem 3474 Tryon Circle <br /> Carson,CA 90746 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696420 CAD982446858 CALOOOII0021 CAL000091507 CAL000214411 <br /> Source: Ll Collection Station ❑Government Genem or&tce fres that it has established a program to reduce the volume or <br /> quantity oxicity 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 /> bind the above listed generator to the terms on the reverse <br /> Retain sample # 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 /> closure 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 /> and not these more ingent requirements. This notification is for information purposes only. <br /> D var Rionnhire Print Nnmr Rnnta lk llom <br />