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JWORK ORDOSERVICE AGREEMENT <br /> Evergreen Environmental Services No !�6 <br /> dedicated to the protertion ajthe rrrvin#uaenr yy (, r J J'I t ` 1� <br /> -•/� To schedule a pickup, call Send paymehI to: (� �(`-( JJ t Sales Order# <br /> 800-596-9455 Evergreen Oil, Inc. <br /> 6880 Smith Ave.•Ncwnrk,CA SPA#CAD982413262 P.O.BOJ(30217 <br /> 16540 S.San Pcdeo SL,Crrmm.CA EPA#CAD981-413262 Los Angeles,CA 90030-0517 Date: <br /> GENERATORIJOB LOCATION BILLING INFORMATION <br /> NAME NAME CASH ❑CHECK <br /> H <br /> ADDRESS + ADDRESS CUSTOMER CODE NO. <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> PHONF.NO. PHONE NO. PROFILE NO. CUSTOMER EPA 11)NM <br /> PRODUCTWASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NU <br /> Used <br /> Used oil,Non-RCRA Hazardous Lubricating CA221:1 . _ Gal, <br /> Waste,Liquid Industrial CA221 Gal. <br /> n.ip Aurwbmkc Anifrcers.Nrn-RCRA Hwa+Mv. CA 134 Gal <br /> wa.mu <br /> rpw:wa t'umtovibk l,i4+iJ.N.G.S.Nn CA231 <br /> 19at Illieil mm:mivxd x;iN MI, pi rMl/1r0+ Gal. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA22) Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Drained Used Oil Fillers Drum <br /> Yon-RCRA Hazardous Waste Solid,(oily debris) CA223 Drum <br /> Empty Drums Drum <br /> Tlrnsponadon His. <br /> Non Hazardous Water Gal <br /> Glycol Bulk W50 Gul. <br /> Glycol Bulk Cone. Gal. <br /> TEST:C Clor D Tech 40W--.,pm ❑ClorD Tech 1000❑Pass❑Fail ❑ Halogen Detectur/Rame Test ❑Pass ❑Fail <br /> Field Service Work Description: TUtal Charges <br /> Other: <br /> Other. <br /> vacuum Services Time <br /> Out of Yard On Sitc Off Site—Off Load Stan Off Load End Return to Yard <br /> TSDF ❑ Consolidated Manifest <br /> ❑ Evergreen Oil,Inc. ❑ Eve <br /> g�een Env.Svc. Evergreen Em.Svc, AJS Filter <br /> 6M Smith Ave. Road 306 ❑ 4139 N.Valentine ❑ 15131 Clark Ave. ❑ <br /> Newark.CA 94560 Davis,CA 95616 Fresno,CA 93722 Industry.CA 9]745 <br /> CAD9RORR7418 CAD992446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen Em.Svc. ❑ Evergreen Env Svc. CFR CFR Greenleaf Env.Svc, <br /> 166(A 5 San Perim 745 A West Beneravia ❑ 944 E.Slauson Ave. ❑ 33210 Western ❑ 3474 Taym Circle <br /> Carson,CA 90746 Santa Maria,CA 93454 Los Angelcs,CA 90011 Union City,CA 94587 Valley Springs.CA 95352 <br /> CAD981696420 CAD982446858 CAL000II0021 CAL000091507 CALaM14411 <br /> Generator certifier that it has established a program to reduce the volume or <br /> Source: El Collection Station EJ Government <br /> quantity&toxicity of the hazarilms waste to the degrce determine!by <br /> ❑Marine ❑ Agricultural ❑ Industrial hnereoy ocebmcaIlly practicable. <br /> have read and have the authority. to <br /> bind the above listed generator to the terms on the reverse <br /> Retain sample # 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 nNuirements. <br /> These include mom stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> closure 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 /> and not these more stringent requirements.This notification is for infe nriation purposes only. <br /> Driver Sienature Prim Name Rnuto 8 n..m �......_•...:_n:___..._- .. _ <br /> Z'd 6£66L£660Z sma of oieVd SZZ:l, 60 9Z deS <br />