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WORK O SERVICE AGREEMENT
<br />Evergreen Environmental -Service's
<br />_'417
<br />dedicated to the protection oaf th,, envjr(,?rment NP 514
<br />To schedule a pickup, call Send pa ment to.
<br />Sales Order
<br />800-596-9455 Evergreen Oil, Inc.
<br />0080 3159Ith Ave., Newark, CA LPM CAL)992413262 P.Q. BOX 30517
<br />16540 S. San Pedro St,, Carson, CA EPA* CAD982413262 Los Angeles, ,CA 90030-0517 Date:
<br />GENERATOR/JOB LOCATION BILLLNTG INFORMATION
<br />PRODUCT
<br />NAME
<br />NAME
<br />CASH ®CHECK F�
<br />Used oil, Non-RCRA I3a2ardous Lubricating
<br />CA221
<br />#
<br />ADD S
<br />CA221
<br />CUSTOMER CODE NO.
<br />CITY
<br />HtADDRLEESS
<br />CITY STATE ZIP CO.
<br />�O
<br />CIT
<br />CITY STATE ZIP CO.C0.
<br />tE
<br />�Q ,
<br />PO #
<br />RQ Waste C �1_94. NA I—
<br />l"3 III Nil
<br />_=1
<br />I FOOI/M
<br />—
<br />Gal.
<br />PHONE ?NO.
<br />PHONE NO. PROFILE NO.
<br />CUSTOMER EPA ID NO.
<br />Waste Solids and Sludges
<br />'Gal.
<br />PRODUCT
<br />WASTE MANIFEST
<br />CODE NUMBER
<br />QUANTITY UNITS PRICE AMOUNT
<br />Used oil, Non-RCRA I3a2ardous Lubricating
<br />CA221
<br />A Gal.
<br />Waste, Liquid Industrial
<br />CA221
<br />Gal.
<br />Uftd AUbQVWdW Abtd'�. " A H
<br />Wnte L' U
<br />I Com"
<br />Gal -
<br />RQ Waste C �1_94. NA I—
<br />l"3 III Nil
<br />_=1
<br />I FOOI/M
<br />—
<br />Gal.
<br />Oil & Water, Non-RCkA Hazardous Wane Liquid
<br />CA221
<br />Gal.
<br />Waste Solids and Sludges
<br />'Gal.
<br />Wash Out,
<br />Each
<br />Drained Used Oil Filters
<br />Drum
<br />Non-RCRA Hazardous Was debris)
<br />CA223
<br />Drum
<br />Empty Drums
<br />Drum
<br />Transportation
<br />Non Hazardous, Water,
<br />Gat.
<br />Glycol
<br />Gal.
<br />Glycol Bulk, Conc.
<br />Gal
<br />TEST: O'Clor D'rech 4000 ppm [] Clor D Tech 1000 [] pass E3 Fail E] Halogen Detectoriflame Test 0 Pam El Fail
<br />f Field Service Work De_.,.,tin
<br />othev
<br />Vacuum Services Time
<br />Out of Yard— On Site —Off Site —Off Load Start —Off Load End —Return to Yard
<br />TS -DF 0 Consolidated Manifest
<br />iEvergreen Oil, lnc. Evergreen Env. Svc, Evergreen Env. Svc. M AJS Filter
<br />6880 Smith Ave: Road 30B C J 4139 N. Valentine L_j 15131 Clark Ave, El
<br />"-Newark,t CA 94560 Davis, CA 93616 Fresno, CA 93721` Industry, CA 91745
<br />CAD980887418 CAD98' 2446874 CAD982446892 CAD000097432
<br />DEvergreen Env, Svc. Evergreen Env, Svc. F-1 CFR(CFR Greenleaf Env, Svc.
<br />16604 S. San Pedro El 745 A West Betmlilvia L—J 9;4 E. Slauson Ave. 3 33210 Western IL --J! 3474 Toyon Circle
<br />Camn, CA 90746 Santa Mana, CA 93454 Los A ales, CA 90011 Union City, CA 94587 �V 11 Rri,n4,, CA 95352
<br />CAD981696420 CAD982446858 CAL010181 10021 CAL000091507 , 14 1
<br />Source: Q CoHection StationGenerator certifies that it has established a program to reduce the volume or
<br />Q Government quantity & toxicity Of the hazardous waste to the degree determined by
<br />generator to be economically practicable,
<br />Marine 0 A-aricultural El Industrial g
<br />I I gI hereby certifv that I have read -and have the authority to
<br />Retain Sample # bind the above listed eenerator to the terms nn, the reverse
<br />�Lde Of this form- -
<br />EMPORTAN'T NOTICE REGARDING THE DISPOSITION, OF YOUR OM.
<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 management of used oil, but that is, not required to
<br />Comply with the more stniagent requirements applicable to hazardous waste management facilities. California facilities that handle or prods used
<br />ection and prevention requirements, engineering certifications of tank intei
<br />These include more stringent leak detection al those ui � ts.
<br />oil are required to meet those more stringent requirements, and some out-of-state facilities that process used Oil so meet 0 req Yemen
<br />`pi -of-state facilities that comply only with federal used oil management standards
<br />closure and accidental releases. 11 is lawful to send use& I to out grity, and financial assurances for
<br />and not,these-more stringent -requirements. This notification is for information purposes.,oril
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