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i WORK ORDE: 'ERVICE AGREEMENT Evergreen Envxr�nental Services � No 1Com. a dedicated to the protection of the enviro �nient ,5 •� , 2 1 To schedule a pickup, call Send payment to: Sales Order# 15��ir_J'Z 800-596-9455 Evergreen Oil,Inc. 6880 Smith Ave.,Newark,CA EPAS CAD982413262 P.O. BOX 30517 16540 S. San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles,CA 90030-0517 Date: GENERATOWJOB LOCATION BILLING INFORMATION - NAME CASH❑CHECK❑ t ADDRESS # ADDRESS CUSTOMER CODE NO. 1 �. - i ITY eeSTATE ZIP CO. CITYSTATE ZIP CO. PO# ' I, PHONE NO. PHONE NO. PROFILE NO. CUTOMER EPA I,,D NO. ' t PRODUCT WASTE MANIFEST I CODE NUMBER QUANTITY UNITS PRICE AMOUNT Used oil,Non-RCRA Hazardous Lubricating CA22 P]GZ�6JJ w^"Q Gal. 1 Waste,Liquid Industrial CA221 Gal. tlsed Auhunolive Antlfrrezu,Non-RCRA Hazardous CA 13 /",-rte I aste Lii aid Gal. RQ WWaste Combacribla LigWd.NAS.NA CA221 1 I 1993 111 roil coma¢ilna ttiwith halo ms) FOO LIF002 Gal. Oil&Water,Non-RCRA Hazardous Waste Liquid C 2221 Gal. Waste Solids and Sludges I GaL E i Wash Out Each Drained Used Oil Filters Drum Non-RCRA Hazardous Waste Solids(oily debris) CAM Drum 1. Empty Drums Dr•unt Transportation I-rs. ► Non Hazardous y1ter Gal. ji Glycol Bulk 50/50 G Gal. i Y'1 Glycol Bu Conc. I Gal. to !. TEST: Clot D Tech 400021=4pm ❑Clor D'Tech 1000 Pass❑Fail ❑ Halogen Detector/Flame lame Test ❑Pa)s� ❑Fail I Field Service Work Description: Total Charges i I Other: � Vacuum ervices Timc Out of anti On Site Off Site qff Load Start Off Load End Renu--n to and / I' TS T Consolidated Manifest i Evergreen Oil,Inc. Evergreen Env.Svc, Evergreen Env,Svc. AJS Filter 6880 Smith Ave. ❑ Road 30B ❑4139 N.Valentine ❑ 15131 Clark Ave. ❑ IN / Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Indus tryy,CA 91745 Ic CAD980887418 CAD982446874 CAD982446887 CAD000097432 1, ❑ Evergreen Env.S Evergreen Env,Svc, ❑ CPR 11CFR ❑ Greenleaf Env.Svc, c 16604 S.San P. rD. ❑ 745 A West Betteravia 944 E.Slauson Ave. 33210 Western 3474'royon Circle Corson,CA 9q.46 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City CA 94587 Valley S�Jn�s,CA 95352 CAD98169t 1 0 CAD982446858 CAL000110021 CAL000091507 CAL0002141 t Generator certifies.that it has established a program to reduce the volume or Source: Collection Station Q Government quantity&toxicity of the hazardous waste to the degree determined by ❑Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. I hereby certify that I have read and have the authority to R4'>cfibl sample �,��, -, bind the above listed generator to the terms on the reverse � `r side of this form. IMPORTANT NOTICE.REGARDING THE DISPOSITION OF YOUR OIL. Per California Healtlt 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 i -9il are required to meet those more stringent requirements, and some out-of-state facilities that process used Oil also meet those requirements. These include more stringent leak detection and prevention requirements, engineering certifications of tank i)dtcgrity, and financial assurances for censure and accidental releases. It is lawful to send used oil to out-of-state facilities that comply only witli federal used oil management standards a d not these more stringent requirements.This notification is for information purposes only. I