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y/s WORK OFOR/SERVICE ®R/SERVICEAGREEMENT T Eve ree nvi ental Services NO 9dedicated to the protection of the environment - To schedule a pickup, call Send payment t Sales Order # ECENED 800-596-9455 Evergreen Oil; Inc. P ��1 6880 Smith Ave., Newark, CA EPA# CAD982413262 P.O. BOX 30217 16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Los Angeles, CA 90030-0517 GENERATOR/JOB LOCATION BILLING INFORMAR&MONMENTAL HEA NAMENAME CASH CHECK ❑ ADDRESSADDRESS s CUSTOMER CODE NO. CITY STATE ,,-ZIP CO. CITY STATE ZIP CO. PO # PHONE NO. PHONE NO. PROFILE NO. CUSTONER EPA ID NO. PRODUCT WASTE MANIFEST QUANTITY CODE NUMBER UNITS PRICE AMOUNT Used oil, Non-RCRA Hazardous Lubricating CA221 Gal Waste, Liquid Industrial CA221 Gal Used Aummodw Antifreeze, Non-RCRA Hazardous WasteLiquid - CA134 Gal. RQ Waste Combustible Liquid, N.O.S. NA 1993 inOil contaminated with halo ens) CA221 F001/F002 `-+- Gal. Oil & Water, Non-RCRA Hazardous Waste Liquid CA221 Gal. Waste Solids and Sludges Gal. Wash Out Each Drained Used Oil Filters Drum Non-RCRA Hazardous Waste Solids (oily debris) CA223 Drum Empty Drums Drum Transportation Hrs. Non Hazardous Water Gal. Glycol Bulk 50/50 Gal. Glycol Bulk Conc. Gal TEST: Q Clor D Tech 4000 ppm E] Clor D Tech 1000 Q Pass E] Fail 0 Halogen Detector/Flame Test F] Pass E] Fail Field Service Work Description: Total Charges Other: Other: Vacuum Services Time Out of Yard On Site Off Site Off Load Start Off Load End Return to Yard ' }.. t �DF ❑ Consolidated Manifest Evergreen Oil, Inc. 6880 Smith Ave. Newark, CA 94560 CAD980887418 ❑ Evergreen Env. Svc. Road 30B Davis, CA 95616 CAD982446874 ❑ Evergreen Env. Svc. 4139 N. Valentine Fresno, CA 93722 CAD982446882 AIS Filter ❑ 15131 Clark Ave. El Industry, CA 91745 CAD000097432 ❑ Evergreen Env. Svc. ❑ Evergreen 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 Source: Collection Station Generator certifies that it has established a program to reduce the volume or ❑ 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 Retain sample # bind the above listed generator to the terms on the reverse 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 maybe 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 thL MOIL slihtgcttt lcquileweuts applicable to hazardous waste management facilities. California taclhties 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. These include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for closure and accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards and not these more stringent requirements. This notification is for information purposes only.