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WORD ORDER/SERVICE AGREEMENT <br /> WWIEvergreen Evi Services <br /> dedicated to the pm##mental <br /> of the environment — <br /> To schedule a pickup, call Send payment to: <br /> Sales order# 3 14 2 <br /> 800-596-9455 Evergreen <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA023234 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 <br /> GENERATOR/JOB LOCATION Date: 2-6 <br /> NAME BILLING INFORMATION <br /> AAA Afv _ v NAME CASH❑CHECK❑ <br /> ADDRE S # <br /> �N C��� ADDRESS <br /> CIT �� CUSTOMER CODE NO. <br /> S�O C STS ZIP S7 2A, 2 O. CITY STATE ZIP CO. PO# <br /> PHONE NO. <br /> (Zo 4 6 S_ Z O PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> L® d 3 <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Gal <br /> Waste,Liquid Industrial CA221 <br /> Used Automotive Antifreeze,Non-RCRA Hazardous Gal. <br /> W, <br /> Li uid CA134 Gal <br /> RQ Waste Combustible Liquid,N.O.S.NA CA221 <br /> 1993 In(Oil contaminated with halo ens) F00./22 Gal <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA223 <br /> Non Hazardous WaterOrGal.al. <br /> Waste Solids and Sludges <br /> Wash Out Gal. <br /> Pressure Washer/Steam Cleaner Each <br /> Day <br /> Transportation <br /> Fuel Surcharge Hrs. <br /> Glycol Bulk 50/50/Specify Product % <br /> Gal. <br /> Glycol Bulk Conc./Specify Product <br /> Gal. <br /> TEST:❑ Clor D Tech 4000----ppm ❑Clor D Tech 1000 <br /> ❑Pass E]Fail <br /> Retails sample# 8 <br /> Required Total Charges <br /> Field Service Work Description: [� <br /> Other: <br /> Other: <br /> TSDF [ Consolidated Manifest <br /> Evergreen Oil,Inc. Evergreen DRIVER'R CHECKLLST <br /> L6,J 6880Ever Smith Ave. ❑ RoadOR,Inc.-Davis❑ Evergreen Oil,Inc.-Fresno E <br /> Time Out <br /> Newark,CA 94560 4139 N.Valentine <br /> Cewark, A 94 Davis,CA 95616 Fresno,CA 93722 Properly Labeled <br /> CAD982446874 CAD982446882 ion Start Date Marked <br /> ❑ Evergreen Env.Svc. Eva�an1011 Tnc-Saz�aMazia❑ ping-Tank/Drum Clean1745 A West BetteraviaCSanta Maria,CA 93454 ices Checked: ❑ Oil, ❑ Filters/Drums, ❑AntifreezeCAD982446858 ther services needed ❑Oil, ❑ Filters/Drums,❑Antifreeze <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Ll Collection Station C)Government <br /> quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> bmd the above listed generaLor to the terms on the reverse <br /> 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 /> 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 stringent requirements applicable to hazardous waste management facilities.California facilities that handle or process used <br /> oil are required to meet those more stringent requirements,and some out-of-state facilities that process used oil also meet those requirements. <br /> These include more stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> 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 <br /> and not these more stringent requirements.This notification is for information purposes only. <br /> IE <br /> Z Le Po�,.h t <br /> *ignature Print Name >Zoute# Date Aener �[ <br /> White co Dgnature Print Name D e <br /> py=Customer Copy-Pink&Yellow Copy=Office Use-Green Copy=Attach to manifest-Golden Coov_nrnvPr r:nrn, <br />