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WORK ORDS SERVICE AGREEMENT <br /> Evergreen Envh#nental Services N° 420258 <br /> dedicated to the protection of the environment <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: • [•07 <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NAME #CASH❑CHECK❑ <br /> ADDRESS T ADDRESS CUS OMER CODE NO. <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA m NO. <br /> a+1 ( ) <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 /> UV.AL uiQ6v Andfi.,Non-RCRAttia us CAl3 lqp Gal. J. p DC <br /> RQ Wu¢Combustible Liquid,_N .SNA NA CA22� <br /> i9aa m oa rnnummvm wiw hulr F001/F002 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 Drum <br /> Empty Drums Drum <br /> Transportation Hrs. <br /> Non Hazardous Water <br /> Gal. <br /> Glycol Bulk 50150 Gal. <br /> Glycol Bulk Cone. Gal, <br /> TEST:❑Clor D Tech 4000—ppm ❑Clot D Tech 1000❑Pass❑Fail ❑ Halogen Detector/Flame Test Pass ❑Fail <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuu4 Services Time (� <br /> Out o Yard On Site Off Site Off Load Start Off Load End Return Yard <br /> TS F Consolidated Manifest <br /> Evergreen Oil,Inc. El Evergreen Env.Svc. Evergreen Env.Svc. AJS Filter <br /> 6880 El <br /> Smith Ave. Road 30B 4139 N.Valentine 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> Evergreen Env.Sv ❑ 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 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD98169 CAD982446858 CALOWIIO021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station 0 Government quantity&toxicity of the hazardous waste to the degree determined by <br /> 0 Marine 0 Agricultural 0 Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> Retain sample # 71 7 3 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 requited 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 /> sureand accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> a not these more stringent requirements. This notification is for information purposes only. <br /> D ver Siirnature nt 1e.__ r� . <br />