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V <br />AWORK ORDV R/SERVICE AGREEMENT <br />Evergreen Envi. nmental Services <br />det'licated to the protection ofthe enviroriment N9 411.5 7 6 <br />To schedule a pickup, call Semi paymem 'w; Sales Order# <br />800-596-9455 Evergreen Oil, Inc. <br />6880 Smith Ave., Newark, CA EPA# CAD982413262 P.O. BOX 30517 <br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Los Angeles, CA 90030-0517 Date: <br />(;FNFRATORLIOR I.00ATION RILLING INMIRMATI"N <br />NAME <br />NAME <br />CASH [] CHECK <br />ADDRESS <br />ADDRESS <br />CUSTOMER CODE NO. <br />CITY STATE ZIP CO. <br />CITY STATE ZIP CO. <br />PO <br />PHONE NO. <br />PHONE NO. <br />PROFILE NO. <br />CUSTOMER EPA ID NO. <br />Fresno. CA 9371-2 <br />Industry, CA 91745 <br />CAD980887418 <br />CAD9824-461-24 <br />PRODUCT <br />WASTE MANIFEST BER QUANTITY UNITS PRICE AMOUNT <br />mt.Nuii-iCRA llizalJou, Labii�:atlag <br />(_'A Gal. <br />LU6ej <br />W <br />Waste, L,iquid industrial <br />CA221 Gal. <br />Aw, W R <br />e Liquid <br />CA 134 Gal. <br />NV,tC.mbmtibl, Liq N <br />W) , ,, <br />_12 93 al (DipGal. <br />CA221 <br />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />CA221 Gal. <br />Waste Solids and Sludges <br />Gal. <br />Wash Out <br />Each <br />Drained Used Oil Filters <br />Drum <br />Non-RCRA Hazardous Waste Solids (oily debris) <br />CA223 Drum <br />Ellifity I)runis <br />Drum <br />Transportation <br />Hrs. <br />Non Hazardous Water <br />Gal. <br />(.'ilvcol Bulk 50/50 <br />Gal. <br />Glycol Bit* Colic. <br />Gal. <br />TEST: ❑ Clor D Tech 4M0 ppm ❑ Clor D Tech 1000 0 Pass E] Fail 0 Halogen Detector/Flame Test Ej Pass 0 Fail <br />Field Service Work Description: 3.1 QwLcs <br />Other <br />Other <br />Vacuum Seivices Time <br />Out ofYard____On Site __—OffSite --Off Load Stmt ---Off Load End _—Return to Yard -- <br />TSDF <br />❑ Consolidated Manifest <br />Llcl�Iccll Oil, Inc.1:.\C1,l <br />LI <br />1,,m. Si(. <br />LJ " <br />. L\ClfeCn Lit\. i\C. <br />lik <br />❑ \I I <br />115-131 <br />688(1Sniilh Ave. <br />Road 32�13 <br />4131) N. Valentine <br />Clark Ave, <br />Newark, CA 94560 <br />Davis. CA 95616 <br />Fresno. CA 9371-2 <br />Industry, CA 91745 <br />CAD980887418 <br />CAD9824-461-24 <br />CAD982-44088-1 <br />CAJ)000097432 <br />Dogrecil Eliv. S\c, ul-l� (I R (ireelfleal Fin. S\C, <br />❑ it _-604! _j 3-174 Tryon Cilcle <br />S. Sail Pedro 74.� A west Bejtcj'Lo,i;j LJ �)-14 E. SIA[SiM Aye. ,3'10 We tern <br />Carson. CA 90740 Simla Maria. CA 93454 Los Alivle+, CA 90fl1I Union City, CA 94587 Valley Springs. CA 95352 <br />CAD98109(420 CAD981_4468,58 CA 1,000 11 M21 CAL000091507 CAD11002 14411 <br />lot c,!iiities that it hay established a program to reducc� the voloilie of <br />Source: J Collection Statim J Govenii-iient & toXiCi[V of ThC h4ZaldOUS waste io the dqrce determined by <br />IJ Marine LJAuricultural J Industrial <br />g or to be economic -Illy pra,:Ii,-able. <br />I hereby certify that have read and have the authority to <br />bind the above listed termsgenerator to the terms on -zhe reverse <br />Retain Retasample # 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 custoltier'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. Calitoritia facilities that handle or process used <br />()if are required 10 meet thOSe 11101-C strnq,ent rquirenients, and some otit-of-state facilities that process used oil also oice[ those requirements. <br />'I hesc include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for <br />(Ansure and accidental releases. It is lawkil to send used oil to out -of --state facilities that comply only with federal used oil nianagerneut standards <br />and toot these more strinaent requirements. This notification is for information purposes only. <br />Oriver Sii,Tlnfllre Print Nit-ne Route # Date : Gonerwcir'� Siuniatire Print Narne. Date <br />