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t • WORK ORDAERVICE AGREEMENT <br />'Evergreen Environmental Services No F A <br />dedicated to the porter tion of the envitrmnient <br />598 <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#CAD992313262 Dept. LA 23234 �� <br />16530 S. San Pcdru Sr. Ca,oa, CA EPA# CAD982413262 Pasadena. CA 91185-3234 Date: <br />#GENERATOR/JOB LOCATION BILLING INFORMATION <br />NAME <br />' i ��. 1✓tI�C. .HTn • <br />NAME <br />CASH [:] CHECK E] <br /># <br />DRESS <br />ADDRESS <br />Clf,$9�0.��R ypp�NQ, <br />CITY STIE ZIP CO. <br />14A C.. C4 i' 3 <br />CITY <br />STATE ZIP CO. <br />F'Oq <br />PHONE NO. <br />s-7 ._7111 <br />PHONE NO. <br />t 1 <br />PROFILE NO. <br />CUSTOMER EPA ID NO. <br />PRODUCT <br />WASTE <br />CODE <br />MANIFEST QUANTITY UNITS PRICE <br />NUMBER <br />AMOUNT <br />Used oil, Non-RCRA Hazardous Lubricating <br />CA221L <br />761 %O 1 UV <br />Gal. <br />Waste. Liquid Industrial <br />CA221 <br />Gal. <br />wane Lw e�irc MW@m. Nw-RCRA <br />CA134 <br />Gal. <br />RQWarm CmnM1UNss' LiquN.NU S. NA <br />IW1111 011emromnunJ- bolo enel <br />CA321 <br />IYC 221 <br />Gal. <br />Oil & Water. Non-RCRA Hazardous Waste Liquid <br />CA223 <br />Gal, <br />Non Hazardous Water <br />Gal. <br />Waste Solids and Sludges <br />Gat. <br />Wash Out <br />Each <br />Pressure Washer/Steam Cleaner <br />Day <br />Transportation <br />Hrs. <br />- <br />Fuel Surcharge <br />Glycol Bulk SN5�ISpecify Product <br />Gal. <br />Glycol Bu oncJSpecify Product <br />Gat. <br />tFST: CIorDTech 4087—ppm <br />0CIorDTech 1000 <br />ZfNss Fail <br />Retain Sample # <br />Required <br />Total Charges <br />Field Service Work Description: ' <br />Other: <br />Other: <br />TSI) [ff Consolidated Manifest <br />,L -y,{ Evergreen Oil, Inc. Evergreen Oil, Inc. - Davis Evergreen Oil, Inc. - Fresno <br />6880 Smith Ave. ❑ Road 30B ❑ 4139 N. Valentine <br />Newark, CA 94560 Davis. CA 95616 Fresno, CA 93722 <br />CAD980887418 CAD982446874 CAD982446882 <br />Evergreen Env. Svc <br />16 <br />fififld S. San P,iz <br />DRIVER CHECKLIST <br />Time In Time Out _ <br />Tank/Drum Properly Labeled <br />Accumulation Start Date Marked <br />House keeping - Tank/Drurt Clean <br />Other Services Checked: O OiL O Filters/Drums, O Antifreeze <br />04 <br />Generator certifies that it has established a program to reduce the volume or <br />Source: dCollection Station ❑ Government quantity & toxicity of the hazardous waste to the degree determined by <br />C3 Marine C] Agricultural ❑Industrial generator to be economically practicable. <br />I here y certtfv that I have read and have the authority to <br />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 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 />c1o$bre and accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil m:magemem standards <br />and not these more stringent requirements. This notification is for information purposes only. <br />f <br />U fiver Signature Print Name Route # Date Generator's Signature Print Name Date <br />Whltw Cnrnl=CucMmwr f`nrnc - Pink R Vann- rnev_raMn 1 Inn - r]....,., - --a_,.. i. -u-_ n-.-_ - <br />