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-r WORK ® SERVICE AGREEMENT <br />..Evergreen Environmental s O <br />0*;dedicated to the protection of the environment N 52-8247 <br />lIECEIVED <br />To schedule a pickup, call Send payment Sales OrdeA# D141 �?�e <br />800-596.9455 Evergreen Oil, Inc. SEP 0 9 11 <br />S S t�yigth Ave.; Newark, CA EPA# CAD982413262 P.O. BOX 30217 r� <br />Sg O S San Pedro St., Carson, CA EPA# CAD982413262 Los Angeles, CA 90030-0517 <br />`654® TOR/JOBLOCATION BILLING INFO N1 AL HEA <br />AD <br />®T7E <br />I <br />TSPF <br />NAME <br />K� <br />( <br /># ASH E] CHECKE] <br />Env. Svc. <br />Road 30B <br />ADDRESS <br />iCUSTOMER <br />CODE NO. <br />ST. TE ZIP C51y CO. <br />CITY <br />STATE ZIP CO. <br />PO # <br />�• r <br />CAD982446882 <br />CAD000097432 <br />NO. <br />PHONE NO. <br />PROFILE NO. <br />CUSTOMER EPA ID NO. <br />TSPF <br />" Consolidated Manifest <br />A Evergreen Oil, Inc.F1Evergreen <br />6880 Smith Ave. <br />Env. Svc. <br />Road 30B <br />❑ Evergreen Env. Svc. <br />4139 N. Valentine <br />1:1AJS Filter <br />15131 Clark Ave. <br />d Newark, CA 94560 <br />Davis, CA 95616 <br />Fresno, CA 93722 <br />Industry, CA 91745 <br />CAD980887418 <br />CAD982446874 <br />CAD982446882 <br />CAD000097432 <br />F] Evergreen Env. Svc. ❑ Evergreen Env. Svc. ❑ CFR 11CFR Greenleaf Env. Svc. <br />16604 S. San Pedro 745 A West Betteravia 944 E. Slauson Ave. 33210 Western 3474 Toyon Circle <br />Carson, CA 90746 Santa Maria, CA 93454 Los Angeles, CA 90011 Union City, CA 94587 Valley Springs, CA 95352 <br />CAD981696420 CAD982446858 CAL000110021 CAL000091507 CAL000214411 <br />Generator certifies that it has established a program to reduce the volume or <br />Source: 0 Collection Station El Government quantity & toxicity of the hazardous waste to the degree determined by <br />❑ Marine ❑ Agricultural ❑ InduStllal 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 />Retail' Sample # 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 shipment of used oil may be <br />tr3liions <br />licable <br />cora ly with more stringent requirements applicable to hazardous ility that is required to comply with federal twaste pmanagemen tae fitiese California facnt of used oil, ilities that handlt that is not e ore required <br />used <br />comp Y required to meet those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements. <br />oil <br />These include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for <br />�dand <br />of these more,requirements. nts. This not ficat ontal releases. It is lawM to send tios for information onlities that comply only with federal used oil management standards <br />1 ` <br />