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WORK ORDER/SERVICE AGRE EMEA NT <br /> Evergreen Envimniental Services N° ���r <br /> dedicated lo the protection of the envirowilelt! _ a <br /> To schedule a pickup,call Send payment to: Sales Order# �✓ 7 � ' <br /> 600-596-9455 Evergreen Oil,Inc. <br /> '6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 <br /> 16540 S.San Pedro St.,Carson,CA EPAtI CAD982413262 Pasadena,CA 91185-3234 Date: <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> 4E rAl I NAME CASH[]CHECK E <br /> ADDRESS j ADDRESS <br /> CU Or 4E;ji . <br /> CITY STATE ZIP CO. CITY STATE ZIP CO, P <br /> PHONE NO. PHONE NO. PROFILE NO. CUST MER EPA ID NO, <br /> 7 E3') ( �' 7`I' ( ) cB <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER i <br /> I <br /> Used oil,Non-RCRA Hazardous Lubricating CA2266� Gal, <br /> Waste,Liquid industrial CA221 Gal <br /> Used AutornMht Andfrem,Ron-RCRA liarsrdous (-•A134 Gal. <br /> waste Li uid <br /> RQ KSste Com[ustiblc Liqutd,R.O.S.tiA CA221 <br /> 993 In covamiosled iviN foto ens r-W I7r002 Gal. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA223 Gal, <br /> Non Hazardous Water Gal. <br /> Waste Solids and Sludges Gal. ' <br /> Nash Out Each <br /> Pressure Washer/Steam Cleaner Day i <br /> Transportation gra <br /> Fuel Surcharge tyo <br /> i Glycol Bu50/ !Specify Product Gal. <br /> j:G:P:Jy:coiB1'k' <br /> ncJSpecify Product Gat. <br /> TSr D Tech 4000 pili []Clor D'rech 1000 Pass ❑Fail <br /> Retain sample# Total Charges <br /> Required <�i <br /> Field Service Work Description: <br /> Other: <br /> Other: <br /> yEvergreep <br /> Consolidated Manifest DRIVER CHECKLIST <br /> Oil,Inc. EwrgrewOil,Inc.-Davis Evergreen Oil,la c.-Fresno El11meIn IinieOut <br /> th Ave. ❑ Road 30B ❑4139 N.Valentine <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 0 T'ank/Druni Properly Labeled <br /> CAD980887418 CAD982446874 CAD982446882 ❑Accumulation Start Date LN-larked <br /> Evergreen Env.Sv &%ven02,lt?~-Syth1ab Cl House Keeping-Tunk/Drunt Clean <br /> -16604 S.Sim-Pe ❑ 745 A-1VW Bettemvia ❑ <br /> Carson,CA 90 6 Santa Mada,CA 93454 ❑011ier Seivices Ches:W 4'Oil 'Ll'Filicrs/t)itinis;•Ll t\6i)treeic•... ' <br /> CAD981696 CAD982446858 ❑Called in outer Sen•ices necdcd p Oil, ❑.Filters/Dnuns,❑Antifreeze <br /> SOUrCe:: C011eCtiOri Station Generator certifies that it has established a program to reduce the volume or <br /> 0 GoVellllllent quantity&toxicity of the hazardous waste to the degree determined by <br /> Q Matine. ®Agricultural ® Industrial generator to be economically practicable. <br /> I hereby certify_that I have read and have the authority to <br /> hind the above listed generator to the terms nn the revers <br /> side of this form <br /> IMPORTANT NOTICE REGARDING THE DISPOSITION OI''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 comply with federal regulations applicable to ma agement of used oil,but that is not required to <br /> m <br /> comply with the more stringent requirements applicable to hazardous waste management f cilities.California facilities that handle or process used <br /> { it are uired to meet those more stringent requirements,and some out-of-state facilitie th t process used oil also meet those requirements, <br /> i elude more stringent leak detection and prevention requirements,engineering ce it tions of tank integrity,and financial assurances for <br /> clos re and accidental releases.It is lawful to send used oil to out-of-state Facilities that c nip y only with federal used oil management standards <br /> and these more stringent r quirements.This notification is for information pu oses illy. <br /> river Signature Print Name oute# Date G net tor's Signature Print Nan Date <br /> White Copy,Customer Copy-Pink&Yellow Copy=Office Use-Green Coov= Itach to manifest•Golden t nnv_firivar t nnv <br />