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WORK ORDER/SERVICE AGREEMENT <br /> ver areen Environmental Services NO- 646037 <br /> dedicated to the proiection of rite environment <br /> 44 To schedule a pickup,call Send pay=ment to: Sales Order# _ <br /> 800-596-9455 Evergreen Oil,Inc. <br /> 6850 Smith Ave.,l\Tewark,CA EPA#CAD982413262 Dept.LA 23234 <br /> 16540S,San Pedro St.,Carson,CA EPA/CAD982413262 Pasadena,CA 91185-3234 Date i �tr. <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> AME ) 4 NAME, CASH[]CHECK(� <br /> dJ e # <br /> ADDRESS ADDRESS CUSTOMER CODE NO. <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> HONE NO. PRONE NO. PROFILE NO. CUSTOilIER EPA ID NO. <br /> La q <br /> PRODUCT WASTE $IANWRST QUANTITY UNITS PRICE <br /> CODE NUMBER AMOUNT <br /> Used oil,Non-RCRA Hazardous Lubricating CA2 Gal. <br /> Waste,Liquid Industrial CA221 Gal <br /> Us,d id <br /> utol nee <br /> ,2Ansize,NOu•t2CRAtfazanfous CA134 <br /> Gal. <br /> RQ\Vane Combusiibla isgn},�,N.O.S.NA —;;CA-- <br /> 00CA22 f <br /> 1497111 U'ieoonmtaatxdwq>htuto ens 1/Wp2 Gal. <br /> Oit&Water,Non-RCRA Hazardous Waste Liquid CA223 Gal <br /> Non Hazardous Water Gal, <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Pressure Washer/Steam Cleaner Day <br /> Transportation <br /> His, <br /> Fuel Surcharge % <br /> f Glycol Bulk 5 SO/Specify Product Gal. <br /> Glyc, But ConcJSpecify Product <br /> Gal. <br /> TESTI` Clor D Tech 4000ppm O Clor D Tech I0o0 Pass []Fait <br /> Retain Sample# Total Char es i <br /> Required <br /> Field Service FVork Description: <br /> Other: <br /> Other: <br /> I <br /> TS Consolidated Manifest F IVER CH IST <br /> Evergreen Oil,Inc. El Evergreen Oil,Inc.-Davis❑Evergreen Oil,Inc.-Fresno p Timc In I' tttimc O <br /> 6880 Smith Ave. Road 348 4139 N.Valentine <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 ❑Tlrnk/Drunr Properly Labeled <br /> CAD980887418 CAD982446874 CAD982446882 ❑Accumulation Start Date Marked i <br /> Evergreen Env,Svc. Et *n0it,hr-S�nCtivl�ia ❑House Keeping-Tank/Drum Clean <br /> ...............................16604 S.Sau Pedr .......74 <br /> AN We-st-Betteravia ............ <br /> Carson,CA 907 $arta h1aria,CA 93454 0 Other S&irkbs Checked:'❑Oft;"❑FiltcFs/Dtiiins, 1 Antifreeze"` <br /> CAD98I6964 CAD982446858 G Called in other services needed Oil, p Filters/Drums, Antifreeze. <br /> SOlIrCe: Colleetioll Station ®GovelYuneut Generator certifies that it has established a program to reduce the volume or <br /> quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑Marine ®Agricultural ®Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> bind the above listed generator to the terms on the reverse <br /> side of this form <br /> IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br /> Pet•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 comply 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 re uirements,and some out-of-state facilit' s that process used oil also meet those requirements. <br /> i. 'hese include more stringent leak detection and prevention requirements,engineering rtifications of tank integrity,and financial assurances for <br /> C, re and accidental releases.k is lawful to send used oil to out-of-state facilities the omply only with federal used oil managerrlent standards i <br /> ld tot these more stringent requirements.This notification is for information purpose ly. i <br /> " � I <br /> river Signature Print Name Route# ".i Date Gen ignature Print Name Date <br /> While Copy=Customer Copy-Pink&Yellow Copy-Office Use-Green Copy--Attach to manifest-Golden Copy=Driver Copv <br />