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F/ WORK ORD SERVICE AGREEMENT 1 .evergreen Enviimental Services o F N-440421 dedicated to the protection of the environment To schedule a pickup, call Send payment to: Sales Order # 800-596-9455 Evergreen Oil, Inc. 6880 Smith Ave.,Newark,CA EPA#CAD982413252 P.O. BOX 30517 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles,CA 90030-0517 Date:/ GENE,RATOR/JOB LOCATION BILLING INFORMATION NAME NAME CASH❑CHECK❑ r. # ADDRESS ADDRESS CU,S'FOMER CODE N0. CITY r STATE ZIP CO. CITY, STATE ZIP CO. PO# ! (Aa I PHONE NO, PHONE NO. I CUSTOMER EPA ED N0, j I. )33 UAZ ( > Lc00o ZRI Pt WASTE MANIFEST PRODUCT QUANTITY UNPTS PRICE CODE NUMBER AMOUNT F Used oil,Non-RCRA Hazardous Lubricating CA2 2¢i50-L-� i t7"35— Gal. I' Waste,Liquid Industrial CA221 Gal.- Used Automotive Aollfieeze:Nm-RCM Hazardous CA134 Gal. Wwt Li aid RQ Waatc Combustible Upid,N.OS.NA CA221 199 111 OII co am',wlcd with haio�nsl F001/F002 Gal. Oil&Water,Non-RCRA Hazardous.Waste Liquid CA221 Gal. Waste Solids and Sludges Gal. Wash Out Each i t' Drained Used Oil Filters Drum Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum Empty Drums Drum Transportation Hrs, 1 ' Non Hazardous Aer Gal. Glycol Bulk 50150 Gal, Glycol B/, Conc. ` Gal. TEST;] Clor D Tech 40420—ppm ❑Clor D Tech t000 Pass ❑Fail ❑ Halogen Dctector/Flame Test Pass ❑Fail Field Service Work Description: Total Charges { i f I' Other: it Other: t, Vacuum Sel 'ccs Time f Out of Y d . On Site Off Site Off Load Start Off Load End Return to Yard .� .^^ � i I. rSL4� Consolidated Manifest reenOil,Inc. Ever reen Env.Svc. Ever Teen Env,Svc. AJS Filter Smith Ave. ❑ Road 30B ❑4139 N. Valentine ❑ 15131 Clark Ave: ❑ - ii Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Industryy,CA 91745 CAD980887418 CAD982446874 CAD982446882 CAD 000097432 i' Evergreen Euv, c. Evergreen Env.Svc. CFR CFR Greenleaf Env.Svc. ❑ 16604S.San P dro ❑ 745 A West Betteravia❑ 944 E.5lauscn Ave. ❑ 33210 Western ❑ 3474 Toyon Circle Carson,CA 746 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 j CAD98169 20: CAD982446858 CAL000110021 CA1000091507 CAL000214411 Generator certifies that it has established a progniln to reduce the volume or Source: 16 Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by 1 ❑Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. I hereby certify that I have read.and have the authority to bind the above listed generator to the terms on the reverse Retain.sample #Z_ C.Z,. side of this form EMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. Per California Health 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 requited to I' comply with the more stringent requirements applicable to hazardous waste management facilities.Califoinia facilities that handle or process used Oil are required to meet those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements. Tllesse include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for' c s,1.ue and accidental.releases.It is lawful to scud used oil to out-of-state facilities that comply only with federal used oil management standards { a dtnot these more stringent requirements.This notification is for information purposes only. , I 1YR1111 Me= &rte"