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TESTE] Clor D Tech 4000 ----ppm ❑ Clor D Tech 1000 ❑ Pass ❑ Fail ❑ Halogen Detector/Flame Test ❑ Pass ❑ Fail Field Service Work Description: Other: Other: Vacuum Services Time Out of Yard On Site Off Site Off Load StartOff Load End Return to Yazd TSDF WORK 0R/SERVICE AGREEMENT ❑Evergreen Oil, Inc. 6880 Smith Ave. Evergreen Environmental Services ❑ Evergreen Env. Svc. 4139 N. Valentine AJS Filter ❑ 1:1 dedicated to the protection of the environment ° 530141 Fresno, CA 93722 15131 Clark Ave. Industry, CA 91745 A / CAD982446874 CAD982446882 To schedule a pickup, call Send payment to: Sales -JCp��7/ 00-596-9455 Evergreen Oil, Inc. Order # 6880 Smith Ave., Newark, CA EPA# CAD982413262 16540 S. San Pedro St., Carson, CA EPA# CAD982413262 P.O. BOX 30217 Los Angeles, CA 90030-0517 Date: , —00 GENERTTOR/JOB LOCATION BILLING INFORMATION - TESTE] Clor D Tech 4000 ----ppm ❑ Clor D Tech 1000 ❑ Pass ❑ Fail ❑ Halogen Detector/Flame Test ❑ Pass ❑ Fail Field Service Work Description: Other: Other: Vacuum Services Time Out of Yard On Site Off Site Off Load StartOff Load End Return to Yazd TSDF Consolidated Manifest ❑Evergreen Oil, Inc. 6880 Smith Ave. CASH ❑ CHECK ❑ Evergreen Env. Svc. 4139 N. Valentine AJS Filter ❑ 1:1 Newark, CA 94560 Davis, CA 95616 Fresno, CA 93722 15131 Clark Ave. Industry, CA 91745 A / CAD982446874 CAD982446882 ADDRESS # C TOMER COD NO. ST CO. CITY STATE ZIP CO. O # ►i ONE PHONE NO. PROFILE NO. O R EPA N . PRODUCT WASTE CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT Used oil, Non-RCRA Hazardous Lubricating CA221 Gal Waste, Liquid Industrial CA221 Gal Used Automotive Antifreeze. Non-RCRA Havacdous Waste Li uid CA13 Gal RQ Waste Combustible Liquid. N-O.S. NA 1993 nt (Oil wnianunated 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 His Non Hazardous Water Gal Glycol Bulk 50/50 Glycol Bulk Conc. x Gal TESTE] Clor D Tech 4000 ----ppm ❑ Clor D Tech 1000 ❑ Pass ❑ Fail ❑ Halogen Detector/Flame Test ❑ Pass ❑ Fail Field Service Work Description: Other: Other: Vacuum Services Time Out of Yard On Site Off Site Off Load StartOff Load End Return to Yazd TSDF Consolidated Manifest ❑Evergreen Oil, Inc. 6880 Smith Ave. Evergreen Env.. Svc. Road 30B ❑ Evergreen Env. Svc. 4139 N. Valentine AJS Filter ❑ 1:1 Newark, CA 94560 Davis, CA 95616 Fresno, CA 93722 15131 Clark Ave. Industry, CA 91745 CAD980887418 CAD982446874 CAD982446882 CAD000097432 Total ❑ Evergreen Env. Svc. ❑Evergreen Env. Svc. ❑ CFR CFR 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 Government Generator certifies that it has established a program to reduce the volume or Source: LJ Collection Station quantity & toxicity of the hazardous waste to the degree determined by ❑ Marine ❑ A ncultural ❑ Industrial generator to be economically practicable. I hereby certify that I have read and have the authority to Retain Sample # bind the above lasted 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 may be transported to a facility that is required to comply with federal regulations applicable to management of used oil, but that is not required to Lut"Ply wit11 tale "cute su-ingent requirements applicable to hazardous waste management tacilhtles. C,ahtornra tacilrtres that handle or process used oil are required to meet those more stringent requirements, and some out 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 u ed oil management standards an not these more stringent requirements. This notification is for information purposes only. i