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WORK ORDER/SERVICE AGREEMENT Evergreen Envy ental Services dedicated to the protec Ion of the environment N-0 623118 To schedule a pickup, call Send payment to: Sales Order # 800-596-9455 Evergreen oil, Inc. 6880 Smith Ave., Newark; CA EPA# CAD982413262 Dept. LA 23234 16340 S. San Pedru SL, Carson, CA EPA#r CA1)9824132b2 Pasadena, CA 91185-3234 Date. GENERATOR/JOB LOCATION BILLING INFORMATION NAM& I WASTE MANIFEST CODE NUMBER QUANTITY UNITS NAME Used oil, Non-RCRA Hazardous Lubricating CA2 71-70 CASH ❑CHECK ADDRESS f CA221 ADDRESS # CUSTOMER CODE NO. r Gal Gal. Oil & Water, Non-RCRA Hazardous Waste Liquid CA223 G� CIT STATE ZIP �4zlll C* CO. CITY STATE ZIP CO. PO ## HONE NO. Gal PHONE NO. Wash Out PROFILE NO. CUSTOMER EPA ID NO. -71 Pressure Washer/Steam Cleaner Day 16Z5b1 PRODUCT WASTE MANIFEST CODE NUMBER QUANTITY UNITS PRICE AMOUNT Used oil, Non-RCRA Hazardous Lubricating CA2 71-70 Gal. Waste, Liquid Industrial CA221 Gal. Used Automotive Antifreeze, Non-RCRA Hazardous Waste Li nid RQ Waste Combustible Liquid. N.O.S. NA 1993 III Oil contaminated with halogens) CA13 CA22I F001/F002 Gal Gal. Oil & Water, Non-RCRA Hazardous Waste Liquid CA223 G� Non Hazardous Water Gal Waste Solids and Sludges Gal Wash Out Each Pressure Washer/Steam Cleaner Day TranXBuonc./Specify Fuel % Glycify Product Gal Glyccify Product Gal TES400 ppm ❑ Clor D Tech 1000 Pass ❑ Fail Retain sample Required C. Z Total Char es Field Service Work Description: Other: Other: r6E880 Consolidated Manifest D R CHECKLIST77 rgreen Oil, Inc. Evergreen Oil, Inc. - Davis Evergreen Oil, Inc. - Fresno ❑ Time In Time Out Smith Ave. ❑ Road 30B ❑ 4139 N. Valentine Newark, CA 94560 Davis, CA 95616 Fresno, CA 93722 ❑ Tank/Drum Properly Labeled CAD980887418 CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked ❑ Evergreen Env. Svc. [:]Evrlge�10> 1m-SantaMalia❑ ❑ House Keeping - Tank/Drum Clean 16604 S. San Pedr 745 A West Betteravia ❑ Other Services Checked: ❑ Oil, ❑ Filters/Drums, ❑ Antifreeze Carson, CA 907 Santa Maria, CA 93454 CAD9816964X CAD982446858 ❑ Called in other services needed ❑ Oil, ❑ Filters/Drums, ❑ Antifreeze Generator certifies that it has established a program to reduce the volume or Sour e: Collection Station 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 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 custo' er's shipment of used oil may be transported to a facility that is required to comply with federal regulations applicable to management of ed oil, but that is n quired to comply with the more stringent requirements applicable to hazardous waste management facilities. Calif rnia facilities a le or process used oil are required to meet those more stringent requirements, and some out-of-state facilities that process ed oil 6alsoet th e requirements. These i Jude more stringent leak detection and prevention requirements, engineering certifications of t nk intd ancial assurances for closur a d accidental releases. It is lawful to send used oil to out-of-state facilities that comply only wi ermanagement standards and n t ese more stringent requirements. This notification is for information purposes only. Signature ^ Print Name _ Route # ^ ry ate / Generator's Signature _ Print Name_ Date