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JWORK GRDY 'SERVICE AGREEMENT <br /> AIR Evergreen Enviroximental Services N® 515- 4 7 <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 Dept.LA 23234 <br /> 16540 S.San Pedro SL,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: i H L-Q <br /> GENERATORIJOB LOCATION BILLING INFORMATION <br /> .91-NAME NAME CASHE] CHECK <br /> A # <br /> ADDRESS ADDRESS CUST MER CODE NO. <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> CA 7wp�f <br /> PHONE N . PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> 5" c �cC� <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Automotive Antifreeze,Non-RCRA Hazardous i <br /> - --- —CA-13 - -� - - --Gal.-- —- - — -- --- - <br /> RQ Waste Combustible Liquid,N.O.S.NA CA221 <br /> 1993 m(Oil comaminated with halo ens) F0011F002 Gal. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid C_A223 Gal. <br /> Non Hazardous Water Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> x <br /> Pressure Washer/Steam Cleaner Day <br /> Transportation Hrs. <br /> Fuel.Surcharge % <br /> Glycol Bulk 50/50/Specify Product Gal. <br /> Glycol Bulk Conc./Specify Product Gal. <br /> TEST:❑ Clot D Tech 4000 ppm Clor D Tech 1000 Pass Fail <br /> Fe <br /> etain Sample# Total.Charges <br /> quired ,.,,Z,z <br /> Field-Service Work Description: - - ---.- - - -- -- <br /> Other. <br /> Other: <br /> TS Consolidated Manifest DRIVER CKLIST <br /> Evergreen Oil,Inc. ❑ Evergreen oil,Inc.-Davis[:] Evergreen Oil,Inc.-Fresno ❑ Time In Time Out <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 ❑ Tank/Drum Properly Labeled <br /> CAD980887418 CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked <br /> Evergreen /,4vo* <br /> ❑ EvagmmOl Im-SlirmMaoa� ❑ House Keeping-Tank/Drum Clean <br /> 16604 S.S745 A West Betteravia ❑ Other Services Checked: ❑Oil, ❑ Filters/Drums, ❑Antifreeze <br /> Carson,CA Santa Maria CA 93454 ❑ Called in other services needed Oil, Filters/Drums, Antifreeze <br /> CAD98169 CAD982446858 ❑ ❑ ❑ <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: lCollection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby cettifv that I have read and have the authori_ to <br /> bind the above listed generator to the terms on the reverse <br /> side of this form. <br /> BIPORTANT 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 manag ent of used oil,but that is not required to <br /> comply with the more stringent requirements applicable to hazardous waste management facili s.California facilities that handle or process used <br /> oil are required to meet those more stringent requirements,and some out-of-state facilities that ivocess used oil also meet those requirements. <br /> se include more stringent leak detection and prevention requirements,engineering c ficati ns of tank integrity,and financial assurances for <br /> cl ure and accidental releases.It is lawful to send used oil to out-of-state facilities th t mply ' y with federal used oil management standards <br /> d not these more stringent r quirements.This notification is for information purp se y. <br /> river Signature Print Name Route# Date enera s Lure Print Name Daffe <br />