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WORK OKEJSERVICE AGREEMENT <br /> -21 <br /> Evergreen Environmental Services No 404023 <br /> .,.t/ dedicated to the protection of the em ironmeur <br /> To schedule a pickup, call Send payment to: Salts Order ( 1�177Z <br /> 800-596-9455 Evergreen Oil, Inc. <br /> cd80 Smith Ave., Newark, CA EPA0 CA0982a13262 P.O. BOX 30517 t �� <br /> 13340 S San Pedro St.,Carson. CA EPA#CA0982413262 Los Angeles. CA 90030-Oi 17 Date: <br /> GENERATOR41013 LOCATION BILLING INFORMATION <br /> IE NAME CASH ❑ CHFCIC❑ I <br /> /- <br /> ADDRESS .ADDRESS CUSTOMER CODE NO.j <br /> �C '1 STATE 7� CO. CITh' __-- - STATE -- "LIP T CO. PO <br /> PHONE NO. PHO\E NO. PROFILE NO. CUSTOMER EP-k ID NO, <br /> QCs l ) Ct i Ot 2— <br /> NVASTE NIA\iIFEST <br /> PRODUCT CODE. `UMBER QUANTITY UNITS PRICE AMOUNT <br /> L,cd oil. Non-RCR.A Hazardous Lubricacilt, CA221 1 j Gal, <br /> 1 1t-I,tc. Liquid Industrial C.-1.22 l Gal. <br /> I!wt+ Sen-RCRA H.-.,dog, CAI3-I• Gal. <br /> R+J CA_"1 Gal. <br /> '111 0.1...... lu.+t:J urth h;J,•srn+� FINIl.FQnz <br /> Oil , Wirer,:'tion-RCRA Hazarduus Waste Liquid CA22l Gal. <br /> %%ANte Solids and Sludges Gal. <br /> %k ash Our Each <br /> Drained Used Oil Filters Drum <br /> \on-RCRA lfxanlouU Waste Solid,(oily debris) CA223 Drtlttt <br /> Emyr} Drams Drum -- <br /> Transportation Hrs. <br /> `+on Hazardous Water Gal. <br /> Glycol Bull ;130 Gal. <br /> Glycol Bull zConc. Gal. <br /> TEST: Clor D Tech 40002L-Igppm ❑Clur D Tech 1000 Pass❑ Fail ❑ Halogen DerectorfFiame TestPais [] Fail <br /> F,,ld Service Work Description: Total Charges <br /> other'. <br /> Ocher: <br /> VacuLIM .—ices Time <br /> OUt of and On Site Orf Site Off Load start Off Load End Return to Yard <br /> TS F Consolidated ivianil; -tEv r«r.en Oil. Inc. ❑ EVer_reen Env.Ssc. F} Evergreen Env.Svc. ❑ AJS Filter <br /> 6S•St Smith .Ave. Road 30B L—k 4139`. Valentine 13131 Clark Ave. <br /> Nesvur's.CA 94560 Davis,CA 93616 Fresno.CA 93722 Industry•CA 91743 <br /> CAD`.a11N S74I CAD9S2-W6874 CAD93'-4--6Sa'- C.AD06009743- <br /> Eve,rcc:n Em. S% ❑ Evergreen Ens. Svc. ❑ CFR ❑ CFR Greenleaf Env.S\c. <br /> Io001 S, San P" o 743 A 41re,t Betteravia 944 E. Siuu,++n A\e. 33210 WVesteni 3474 Toyon Circle <br /> C:Ir,tln.CA 91)- 0 Santa Maria,CA 93434 Lo: �1n_ele.•C.A.90011 Union City.CA 94587 Valles Spring;, CA 9;;3? <br /> CAD981fi96= .1 CAD95„4468iS' C.ALDOCTINO'I CALCO061307 CAL000--14411 <br /> Generator certifies that it has estahlkhed a program of rcduc.the volume er <br /> SOL1rCe: Collection ,Station ❑ Government quantity S. to.ticit} of the hazardous \sastc to the dearce rlVtermined by <br /> ❑ Marine ❑ AorlCLlltLlrLil ❑ Industrial gen.ruur to be econumicall}' practi� hie. <br /> I hereby certify that I have read and have the authority to <br /> hind the above listed lveneratdr to the terms on the reverse <br /> Retain sample #�� �.r' L side of this et�rn,- <br /> INIPORTANT NOTICE REGARDING THE DISPOSITIONOF YOUR OIL <br /> Per California Health and Safety Code Section 25250.9, Evergreen hereby advises customer thai Custorner's shipment of toed oil may be <br /> tr:ur.purtcd to a facility that is required to comply with federal re"ulations applicable to management of used oil, but that is nox rcquiretl to <br /> coniply vvirh the more stringent requirements applicable to hazardous waste management facilities. California facilities that handle or process u,e,! <br /> oil arc required to meet those more stringent requirements, and sonic out-of-state facilities [hat process used oil also meet those rregt!irzmznts. <br /> The,: iciclude more stringent leak detection and prevention requirements, enLineering certif3catio• Lit t rity, and financial assurances for <br /> cl .Lire and accidental releases. It is lawful to send Weil oil to out-of-state facilities that com y it r- eral used oil man:agtment standar), <br /> a d nm these more stringent requirements.This notification is for information purposes o <br /> r - <br /> -- i <br />