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"VIPO-/SERVICE AGREEMENT E-Yergreen Envie .imental Services � 486985 dedicated to the protection of'rhe environment To schedule a pickup, call Send payment to: Sales Order # 80'0-595-9455 Evergreen Oil, Inc. 6880 Smith Ave., Newark, CA EPA# CAD982413262 P.O. BOX 30517 16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Los Angeles, CA 90030-0517 Date: GENERATORIJOB LOCATION BILLING INFORMATION NAME t,)VC ' U t� v� NAME AMOUNT CASH ❑CHECK ❑ # A RV n ; C. l ADDRESS Waste, Liquid Industrial S ONIER RDE NO. C Y STA E Z d �CO. f� CITY STATE ZIP CO. P0# N NO. RQ Waste Combustible Liquid. N.0.5. NA 1993 !lt (Oil contaminated with holo^ens) PHONE NO. Gal. PROFILE NO. CUSTOMER EPA ID NO. PRODUCT WASTE MANIFEST CODE NUMBER QUANTITY UNITS PRICE AMOUNT Used oil, Non-RCRA Hazardous Lubricating CA221 Gal. Waste, Liquid Industrial CA221 Gal. Used Automotive Antifreeze, Non-RCRA Hazardous Waste Li uid CA134 Gal. RQ Waste Combustible Liquid. N.0.5. NA 1993 !lt (Oil contaminated with holo^ens) CA221 F001/17002 Gal. Oil & Water, Non-RCRA Hazardous Waste Liquid CA221 Gal. Waste Solids and Sludges Gal. Wash Out Each Drained Used Oil Filters Drum .Q, - Non-RCRA Hazardous Waste Solids (oily debris) CA223 Drum Empty Drums Drum Transportation Hr's• Non Hazardous Water Gal• Glycol Bulk 50/50 Gal. Glycol Bulk Conc. Gal. TEST: ❑ Clor D Tech 4000 ppm ❑ Clor D Tech 1000 ❑ Pass ❑ Fail ❑ Halogen Detector/Flame Test ❑ Pass ❑ Fail Field Service Work Description: Total Charges O q Other: �� Other: Vacuum Services Time Out of Yard On Site Off Site Off Load StartOff Load End Retum to Yard TSDF ❑ Consolidated Manifest ❑Evergreen Oil, Inc. ❑ Evergreen Env. Svc. ❑ Evergreen Env. Svc.❑ AJS Filter ❑ 6880 Smith Ave. Road 30B 4139 N. Valentine 15131 Clark Ave. Newark, CA 94560 Davis, CA 95616 Fresno, CA 93722 Industry, CA 91745 CAD980887418 CAD982446874 CAD982446882 CAD000097432 ❑Evergreen Env. Svc.1:1Evergreen Env. Svc. ❑ CFR 1:1CFR ❑ Greenleaf Env. Svc. 16604 S. San Pedro 745 A West Betteravia 944 E. Slauson Ave. 33210 Western 3474 Toyon Circle Carson. CA 90746 Santa Maria. CA 93454 Los Angeles, CA 90011 Union City, CA 94587 Valley Springs, CA 95352 CAD981696420 CAD982446858 CAL000110021 CAL000091507 CAL000214411 Generator certifies that it has established a program to reduce the volume or Source: ❑ Collection Station ❑ 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 bind the above listed generator to the terms on the reverse Retain sample # 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 are required to meet those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements. They 17 e more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for cInotse ental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards a stringentrequirements. This notification is for information purposes only. -�