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A WORK ORD SERVICE AGREEMENT Evergreen Envi mental Services N® 18 dedicated to the protection of the environment To schedule a pickup, call Send payment to: Sales Order # 800-596-9455 Evergreen Oil, Inc. 6880 Smith Ave., Newark, CA EPA# CAD982413262 Dept. LA 23234 16546 S. San Pedro St., Carson, CA EPA# CAD982413262 Pasadena, CA 911.85-3234 Date: �•~ '"' �' GENERATOR/JOB LOCATION BILLING INFORMATION NAME WASTE MANIFEST CODE NUMBER NAME AMOUNT CASH ❑ CHECK # ADDRESS Gal. ADDRESS Waste, Liquid Industrial NO. C=1Z Gal, ' UsW Automotive Antifreen, Non-RCRA Hazardous Waste Li ala CA 13 - CITY STATE ZIP CO. CITY STATE ZIP CO. PO # PHONE NO. CA223 PHONE NO. PROIFILE NO. CUSTOMER EPA ID NO. Gal. } Gal. ?' PRODUCT WASTE MANIFEST CODE NUMBER QUANTITY UNITS PRICE AMOUNT Used oil, Non-RCRA Hazardous Lubricating CA22 Gal. Waste, Liquid Industrial CA221 Gal, UsW Automotive Antifreen, Non-RCRA Hazardous Waste Li ala CA 13 - Gal. RQ Wasteotnbustible Liquid, N.O.S. NA 1993 117 Oil wntaminated with halo ens Cp221 F001/F002 - - Gal. Oil & Water, Non-RCRAHazardous Waste Liquid CA223 Gal. Non Hazardous Water Gal. Waste Solids and Sludges Gal. Wash Out Each Pressure Washer/Steam Cleaner Day Transportation Hrs. Fuel Surcharge % Glycol Bulk 50/5 pecify Product Gal. Glycol Bulk nc./Specify Product Gal. TEST .: Clor D Tech 40002--p—ppm Clor D Tech 1000 Pass Fail Retain sample # Re uired Total Char es Field Service Work Description: Other: Other: TSr, [Lj Consolidated Manifest DRIVER Evergreen Oil, Inc. Evergreen Oil, Inc. -DavisEvergreen Oil, Inc. - Fresno ❑ Time In Time Out -� 6880 Smith Ave. ❑ Road 30B ❑ 4139 N. Valentine Newark, CA 94560 Davis, CA 95616 Fresno, CA 93722 ❑ Tank/Drum Properly Labeled CAD980887418 CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked ❑ Evergreen Env. Sv ❑ Evag}ee+ (AIm-&&Maria❑ ❑ House Keeping - Tank/Drum Clean 16604 S. San P o 745 A West Betteravia ❑ Other Services Checked: ❑ Oil, ❑ Filters/Drums, ❑ Antifreeze Carson, CA 9 46 Santa Maria, CA 93454 CAD98169 0 CAD982446858 13 Called. in other services needed Oil, Filters/Drums, Antifreeze Source: Collection Station L) Government Generator certifies that it has established a program to reduce the volume or quantity & toxicity of the hazardous waste to the degree determined by ❑ Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. T hereby certify that I have real and have the authority to bind the above listed generator to the terms on the reverse side of this form IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. Per California Health and Safety Code Section 25250.9, Evergreen hereby advises customer that customer's shipment of used oil may be transported to a facility that is required to comply with federal regulations applicable to management of used oil, but that is not required to comply with the more stringent requirements applicable to hazardous waste management facilities. California facilities that handle or process used oil ar required to meet those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements. Th a include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for CIO u and accidental releases. It is lawful to send used oil to out-of-state facilities that co ly my with federal used oil management standards an n t these more stringent requirements. This notification is for information purposes c v /) _ ver Signature Print Name R u� to #14. !(— � / I-.,' Date G rator's 1 ature nt a e nate