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i <br /> 0 <br /> WORK ®RDER/SERVICE AGREEMENT <br /> EVeigreen Enviro mental Services N° Cl 9 <br /> dedicated to the protection of dre environment <br /> 7 1 <br /> To schedule a pickup,call Send paynle.nt to: Sales Order# <br /> 500-596-9455 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: 2.0 <br /> GENERATORIJOB LOCATION BILLING INFORMATION <br /> 4Ee _ NAME CAST{Q CHECK El <br /> # <br /> DS ADDRESS CUSTO 3ER CODE NO. <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. FOlt <br /> PI-10NE NO• PHONE NO. PROFILE NO, CUSTOMER EPA—W--N-01 <br /> y9 t ai <br /> PRODUCT WASTE AANH<EST QUANTITY UNITS PRICE AMOUNT <br /> CODE kMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA22 p 41-0 Gal. <br /> Waste,Liquid hrdusirial CA221 EGA <br /> Uxd AutomotAc Anlinxzt.NAi.RCRAHu dour CA134 <br /> WuteLi vtd <br /> RQR'mrt C,0g 6bl,11gi,1 N.O,S.NA CAY21 <br /> 1993 IR(Oil ctntamrnmt3 r�itA halo•rns 02 Oil&Water,Non-RCRA Hazardous Waste Liquid CA223 Non Hazardous Water <br /> waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Pressure Washer/Stearn Cleaner Day <br /> TYansportation Hrs, <br /> Fuel Surcharge <br /> Glycol Bulk 50 /SpeeifyProduct Gal. <br /> Glycol Bul• 011c./Specify Product Gal. <br /> TEST: Clor D Tech 40 ppm ❑Clor D Tech 1000 Pass n Fail <br /> Retain sample# Total Charge <br /> .Required <br /> Field Service lvork Description: <br /> Other: <br /> Other. <br /> TS Consolidated Manifest DRIVE HECKLIST <br /> Evergreen Oil,Inc, Q Btergreen Oil,Inc.-Davis❑Evergreen Oil,Inc.-Fresno p Time In Time Out_ <br /> 6880 Smith Ave. Road,C Fres o, Valentine O Tenk/Drunr Properly Labeled <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Pe Y <br /> CAD980887419 CAD982446874 CAD982446882 ❑Accumulation Start Date Marked <br /> ElEverg cen Env.Svc. ❑ Hzetgieznpl 6te-S> 11 � D House Keeping-Tank/Dr rn Clean <br /> 16604 ,San Ped 745 A West Betteravia O Other Services Checked:©Oil,.4 Filterrunls,❑Antifreeze. .. .. <br /> CaisouSs/D <br /> ;'CA 907 Santa lvfaiia;CA 93454 <br /> CAD981696P CAD992446858 13 Called in other services needed 0 Oil, Filters rums,0 Antifreeze <br /> SOUl'Ce: Collection Statiolt Q Goveminent 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 /> hereby certify at I have red and have the authorIly to <br /> n t ed a a o 1 �on the reverse <br /> side of this form. <br /> IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br /> Per California Health and Safety Code Section 25250.9,Evergreen hereby advises customer that customer's shipmeotsF f used oil may be <br /> transported to a facility that is required to comply with federal regulations applicable to management of u ed-(511;but that is not required to <br /> comply with the more stringent requirements applicable to hazardous waste management facilities -a 1 omia facilities that handle or process used <br /> »i ar equired to meet those more stringent requirements,and some out-of-state facilities t�h,,,�t- ocess used oil also meet those requirements. <br /> 'rhes it elude more stringent leak detection and prevention requirements,engineedn Kr`frcatioits of tank integrity,and financial assurances for <br /> dost re nd accidental releases,It is lawful to send used oil to out-of-state fa ' r at comp y o ederat used oil management standards <br /> and 1 t hese more stringent requit ments.This notification is for informal' oses Only. <br /> d <br /> D1iv Signature Pri Name Route Date Generator's Signatu Print Name Date <br /> White Copy=Customer Copy-Pink&Yellow Copy--Office Use-Green Copy--Attach to manifest-Golden =Driver Copy <br />