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J WORK ORDFR/SERVICE AGREEMENT Evergreen Envi amental Services NO- 580410 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# CAD982413262 Dept. LA 23234 /� `/ O 16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Pasadena, CA 91185-3234 Date: GENERATOR/JOB LOCATION BILLING INFORMATION PRODUCT WASTE CODE NAME AMOUNT CASH ❑ CHECK rgn Oil, Inc. Waste, Liquid Industrial CA221 Gal. Oil, Inc. - Fresno # AD RE ADDRESS 4139 N. Valentine Fresno, CA 93722 CU TOMER CODE NO. ob OL el -t(- A Non Hazardous Water Gal. CAD982446882 0 ITY <-I S ATE ZIP CO. CITY STATE ZIP CO. PO # v V �� Transportation Hrs. PHONE NO. -L PHONE NO. PROFILE NO. CUSTOMER EPA ID NO Glycol BulAnc./Specify Product Gal. c 1 TEST: grClor D Tech 400L -10 -ppm ❑ Clor D Tech 1000 Pass ❑ Fail Retain Sample # Required L \ PRODUCT WASTE CODE MANIFEST QUANTITY UNITS PRICE NUMBER AMOUNT Used oil, Non-RCRA Hazardous Lubricating CA2 Quy, Gal. rgn Oil, Inc. Waste, Liquid Industrial CA221 Gal. Oil, Inc. - Fresno U, Waste d ALiuidutomotive Antif=w, Non-RCRA Hazardous CA 134 Gal. 0 Smith Ave. Newark, CA 94560 RQ Waste Combustible Liquid, N-0 S- NA CA221 Ga) ,993 in Oil contaminated with hal ns F001/F002 4139 N. Valentine Fresno, CA 93722 Oil & Water, Non-RCRA Hazardous Waste Liquid CA223 Gal. CAD980887418/ Non Hazardous Water Gal. CAD982446882 Waste Solids and Sludges Gal. Wash Out Each Pressure Washer/Steam Cleaner Day Transportation Hrs. Fuel Surcharge % Glycol Bulk 50 /Specify Product Gal. Glycol BulAnc./Specify Product Gal. TEST: grClor D Tech 400L -10 -ppm ❑ Clor D Tech 1000 Pass ❑ Fail Retain Sample # Required L \ Total Charges Field Service Work Description: Other: Other: rr [� ZE Consolidated Manifest DRIVE CHECKLIST rgn Oil, Inc. Evergreen Oil, Inc. - Davis [:]Evergreen Oil, Inc. - Fresno ElTime In Time Out 0 Smith Ave. Newark, CA 94560 Road 30B Davis, CA 95616 4139 N. Valentine Fresno, CA 93722 ❑ Tank/Drum Properly Labeled CAD980887418/ CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked Evergreen Env. Svc 1:1Emgmm0tl,hr--S=Maria� 16604 S. San Pe 745 A West Betteravia Carson, CA 90 6 Santa Maria, CA 93454 CAD98169 0 CAD982446858 Source: 4 Collection Station ❑ Govemment ❑ Marine ❑ Agricultural ❑ Industrial w 1 �❑ House Keeping - Tank/Drum Clean — ❑ Other Services Checked: ❑ Oil, ❑ Filters/Drumz, 0 Antifreeze — ❑ Called in other services needed ❑ Oil, ❑ Filters/Drums, ❑ Antifreeze Generator certifies that it has established a program to reduce the volume or quantity & toxicity of the hazardous waste to the degree determined by generator to be economically practicable. I hereby certify that I have read and have the authority to bind the above listed zenerator to the terms on the reverse side of this form. IMPORTANT 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 required to comply with the more stringent requirements applicable to hazardous waste management facilities. California facilities that handle or process used oil ar riequired to meet those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements. The, nclude more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for clos and accidental releases. It is lawful to send used oil to out-of-state facilities that comply ly with federal used oil management standards and t these more stringent r uirements. This notification is for information p0only.D er Signature rint Name Route # Date nature rint Name Date