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WORK ORD SERVICE AGREEMENT <br /> Evergreen E '--nmental Services <br /> • dedicated to he pt.. ..tion of the environmentNO 5228475 <br /> wr To schedule a pickup,call `enoln'. <br /> P�I,t � E t1t tt3: <br /> 800-59 -9455 �.,( .4- ,:f <br /> 6880 Smith Ave-1'cwark,CA EPA# AD982413262 Evergreen Oil,Inc. Sales Order# <br /> OX 30217 <br /> 16540 S.SanPedro St..Carson,CA A#CAD982413262 Los Angeles,CA 90030-0517 <br /> GENERATOR/.IOB LOCATION Date: <br /> EADDRESS <br /> BILLING INFORMATION <br /> CASH❑CHECK(� <br /> ADDRESS # <br /> CUSTOMER CODE NO. <br /> STATE ZIP CITY <br /> CO. PO <br /> PHONE NO. PROFILE NO. <br /> CUSTORIER EPA ID NO. <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 <br /> Waste,Liquid Gal. <br /> Industrial CA221 <br /> Used Aummutire Autif mxze.Nen-RCRA Hazardous Gal. <br /> Wage Li uid CA 134 <br /> RQ waste Combustible Liquid.N.O.S.NA Gal. <br /> 1993 n/(Oil comamimuted with halo rn.0C•A221 <br /> RKWF0 r- Gal. <br /> Oil&Water.Non-RCRA Hazardous Waste Liquid CA22I <br /> Waste Solids and Sludges Gal. <br /> Wash Out Gal. <br /> DrainedUsed Oil Filters Each <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum <br /> Empty Drums Drum <br /> Transportation Drum <br /> Non Hazardous Water Hrs. <br /> Glycol Bulk 50/50 Gal. <br /> Glycol Bulk Conc. Gal. <br /> Gal. <br /> TEST:❑ Clor D Tech 4000_ppm ❑Clor D Tech 1000❑pass❑Fail Halogen Detector/Flame Test Pass <br /> Field Service Work Description: <br /> ❑ g ❑ ❑Fail <br /> Other: <br /> Other: <br /> Vacuum Services Time <br /> Out of Yard On Site-off' <br /> ite Off ite Off Load Stan <br /> Off Load End Return to Yard <br /> TSDF <br /> Consolidated Manifest <br /> Evergreen Oil,Inc. ❑ Evergreen Erv.Svc. Evergreen Env.Svc. ❑ AJS Filter <br /> 6880 Smith Ave. Road ❑30B 4139 N.Valentine <br /> Newark,CA 94560 Davis.CA 9 16 Fresno,CA 93722 15131 Clark Ave. <br /> EJ <br /> CAD980887418 CAD982446 74 C esno,C 493 2 Industry,CA 91745 <br /> CAD000097432 <br /> Evergreen Env.Svc. Evergreen En <br /> 16604 S.San Pedro .Svc. CFR❑ 745 A West B tteravia ❑ CFR Greenleaf Env.Svc. <br /> Santa Ma <br /> Carson,CA 90746 ria, 94 4 E.Slauson Ave. El 33210 Western 3474 Toyon Circle <br /> CAD9824468 88 93454 <br /> CAD981696420 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CALOW110021 CAL000091507 <br /> ❑Collection Station CALished a pr <br /> 411 <br /> Source: Generator certifies that it has established a program to reduce the volume or <br /> ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑Marine ❑ Agricul ral ❑ Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> Retain sample# bind the above listed generator to the terms on the reverse <br /> side of this form <br /> ImPORTANr 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 co riply 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 /> These include more 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 information purposes only. <br /> Driver Signature Print NameJ. Route# Date Generator's Signature <br /> —..■_ Print Name n,te <br />