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WORK ORDIWERVICE AGREEMENT <br /> �i Evergreen Envilomental Services NO- Q $1. 5 6 2 <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: <br /> WOB BILLING INFORMATION <br /> NAME CASH❑ CHECKADDRESS CUSTOMER CODE NO. <br /> IP CO. CITY STATE ZIP CO. PO# <br /> 750577 <br /> PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT <br /> IWASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> E NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating2 '� Gal. <br /> Waste,Liquid Industrial 21 Gal. <br /> Umd Automotive Antifreeze.Num RCRA Hu rdum 34 Gal. <br /> Waste Li uidRQ Wssts Combustible LiqudN.O.S.NA (103 GaI. <br /> 1991111 Oil conteminatt, with holo n <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 His. <br /> Non Hazardous W r Gal. <br /> Glycol Bulk50/50 Gal. <br /> Glycol Bulk Cone. Go <br /> TEST: Clor D Tech 400j.,M3Qppm ❑Clorr,D Tech 1000 ass ❑Fail ❑ Halogen Detector/Flame est ❑Pass ❑Fail <br /> Field Service Work Description: Total Char es <br /> Other: <br /> Other: <br /> Vacuum Se As Time <br /> Out of Y d On Si[e Off Site_Off Load Start Off Load End Reium Yazd <br /> TS Consolidated Manifest <br /> Evergreen Oil,Inc. F-1Evergreen Env.Svc. Evergreen Env.Svc. 1:1 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 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> Evergreen Env.Sv ❑ Evergreen Env.Svc. � CFR 1:1CFR Greenleaf Env.Svc. <br /> 16604 S.San P 745 A West Beneravia 944 E. Slauson Ave. 33210 Western 3474 Tryon Circle <br /> Carson,CA 90 6 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD98169f CAD982446858 CAL000110021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑Marine ❑ Agricultural ❑ Industrial generator to he 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 0 C, I 4 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 /> ese include more stringent leak the and prevention requirements, engineering certifications of tank integrity, and financial assurances for <br /> 1 ure 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 /> ndno[[hese more stringent requirements.This notification is for information purposes only. �, <br />