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1 <br /> WORK GRE `/SERVICE AGREEMENT <br /> Evergreen Envillwimental Services No 579891 <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 , Y <br /> 16540 S.San Pedro SI.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: Qf3—[,C;v <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NAME C" NAME CASH❑CHECK <br /> N111.Lld # <br /> ADDRESS x� ADDRESS C ERODE NO. <br /> Z Z <br /> CIT ' STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> 7 %y <br /> HQNE NO,. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221k !j Z3 Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Autluuolive Antifreeze.Non-RCRA Huutrdous <br /> Wame Liquid CA 13 - CJ^ Gal. <br /> RQ Waste Combustible Liquid.N.O.S.NA CA221 Gal. <br /> 1993 III(Oil contaminated with hulo em) 1`001/17002 <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA223 Gal. <br /> Non Hazardous Water Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Pressure Washer/Steam Cleaner Day <br /> Transportation Hrs. <br /> Fuel Surcharge <br /> Glycol Bulk 50/ /Specify Product Gal. <br /> Glycol Bulk onc./Specify Product Gal. <br /> TEST:YCI or D Tech 4000Zl-*__ppm ❑Clor D Tech 1000 Pass ❑ Fail <br /> Retain sample# e Tot]es Charges <br /> Required � �. G 3 <br /> Field Service Work Description: <br /> Other: <br /> Other: <br /> Consolidated Manifest DRIVER ECKL <br /> Evergreen Oil,Inc. Evergreen oil,Inc.-Davis Evergreen Oil,Inc.-Fresno C1 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 ❑ Accul»ulation Start Date Marked <br /> ❑ Evergreen f20 <br /> ❑ EvtilL= il,Inc.-Santa Mwa❑ ❑ House Keeping-Tank/Drum Clew) <br /> 16604 S.Sa745 A West Betteravia ❑ Other Services Checked: ❑ Oil, ❑ Filters/Drums, ❑Antifreeze <br /> Carson,CA Santa Maria,CA 93454 <br /> CAD98169 CAD982446858 ❑ Called in other services needed ❑Oil. ❑ Filters/Drums,❑Antifreeze <br /> Source: Collection Station Ll Government Generator certifies that it has established a program to reduce the volume or <br /> quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑ Marine ❑ Agricultural ❑ Industtial 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 more stringent requirements,and some out-of-state facilities that process used oil also meet those requirements. <br /> Theinclude more stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> clo. 1 and accidental releases.It is lawful to send used oil to out-of-state facilities that co_ ly only with federal used oil management standards <br /> an n t these more stringent requirements.This notification is for information purposes,tStily <br /> )` /i <br /> D ver Signature Print Name Route# Date Genet Signature Print Name Date <br />