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WORK ORDER/SERVICE AGREEMENT <br />Evergreen Envienmental Semims, to17 <br />dedicated to the protection of the environment i <br />To schedule a pickup, call Said paYmest to, Sales Order # -- <br />800-596-9455 <br />800-596-9455 Evergreen Oil, Inc. <br />6880 SmithAve., Newark, CA EPA# CAD982413262 Dept. LA 23234 <br />16540.$. San Pedro St, Carson, CA EPA#C_AD982413262 Pasadena, CA 91185-3234 Date 'a <br />GENERATORIJOB LOCATION BILLING INFnRUATInN <br />NAME <br />ADDRESS <br />NAME -- <br />ADDRESS <br />CASH ❑ CHECK ❑ <br />CUSTOMER CODE NO. <br />CITY STATE - ZIP CO. <br />CITY <br />STATE. ZIP. CO. <br />PO # <br />PHONE NO. <br />PHONE NO. <br />PROFILE NO. <br />CUSTOMER EPA ID NO. <br />PRODUCT <br />WASTE <br />.CODE <br />.MANIFEST <br />NUMBER QUANTITY <br />UNITS PRICE <br />AMOUNT : <br />Used oil, Non-RCRA Hazardous Lubricating <br />CA22 <br />,,, „ r <br />". <br />Gal.'s• <br />_ <br />Waste, Liquid Industrial <br />CA221 <br />Gal. <br />Uwd AiNnm A.fif .Non-RCRA rizzmtlms <br />Wu Ci uw <br />CA 134 <br />Gal. <br />RQ Wm CmnMsattc Ltq-dN <br />. AS. NA <br />1991 Most cmuami!:W rliN wswidta <br />G8] <br />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />CA223 <br />Gala <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 />Firs <br />Fuel Surcharge <br />% <br />Glycol Bulk 50/50/Specify Product <br />]EE: <br />Gal. <br />Glycol Bulk Conc./Specify Product <br />Gal. <br />TEST: ❑ Clor D Tech 4000—ppm ❑ Clot D Tech 1000❑Pass. E] Fail ❑pas <br />Field Service Wort. Description: <br />[:]Fail <br />Other. <br />i <br />Other <br />TSDF ❑ Consolidated Manifest <br />Evergreen Oil, Inc. ElRoad <br />tea,Inc. - Davis ❑. Evergreen Oil, Inc. - Fresno <br />r� 6880 Smith Ave: Road 30B 4139 N. Valentine - <br />Newark ,CA94560 Davis, CA 95616 Fresno, CA 93722 <br />CAD980887418 CAD982446874 CAD982446882 i71 <br />❑Evergreen Env. Svc.ElEte@uv Mix-SatdM"F—j itoi } Eta pi .t nt mrum CICr <br />166[4 S. San Pedro 745 A West Betteravia ^it r , ,.> I• , . <br />Carson, CA 90746 Santa Maria, CA 93454 <br />CAD981696420 CAD982446858 <br />Generator certifies that it has established a program to reduce the volume or <br />Source: ❑ Collection Station ❑ GOvemment quantity & toxicity of the hazardous waste to the degree determined by. <br />❑ <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 />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 mote stringent requirements, andsome 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 stringent requirements. This notification is for: information purposes only. <br />Driver Signature Print Name Route # Date Generator's Signature ; Print Name Date <br />