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FWOM ' L. F. W. MFG. INC. FAX NO. 209 465 6521 Mar. 15 2007 11: 27AM P3 <br />W0JZK ORDER/SERVICE AGREEMENT <br />Evergreen Environmental Services Or <br />dedircrrc'<i w rice protection of ibe cavironnld-lit — "' -�` � <br />Tp si:Pledule a pickup,m <br />call Send payment to- Stiles <br />800-596-9455 Evergreen Oil, Inc. <br />6880 Snth Ave., Newark, Cit EPA# CAD982413262 P.O. BOX 30517 j �� <br />16540 S. Sart Pedro St., Carson, CA EPA# CAD982413262 Los ArlgZjCs, CA 90030-0517 late. // <br />Gr.IC,NERATOR/}'OR LOCATION BILLING INFCkRMATTON <br />0 <br />NAME <br />r <br />NAME. <br />UNITS <br />CASH Q CHECK ❑ <br />AMOUNT <br />�J•✓i <br />ADDRESS <br />NO. <br />T;;-- <br />STATE <br />S.r <br />CITY <br />CITY <br />STATE ZIP CO. <br />PO # <br />PKQNF O. <br />�L <br />PHONF, NO, <br />(bid au<omvu�e satire«,� N,in-raC2a rl; r: noun <br />Waw LuW <br />P1R01EU E NO. <br />CUS O1vIE <br />PRODUCT <br />WASTE MANIFEST <br />CODE NUMBER <br />J <br />QUANTITY <br />UNITS <br />PRICK <br />AMOUNT <br />Used oil, Noo•RC2A Hazardous Lubricating <br />_ <br />CA221 <br />Gail. <br />Waste:, Liquid Industrial <br />CA221 <br />Gal, <br />(bid au<omvu�e satire«,� N,in-raC2a rl; r: noun <br />Waw LuW <br />CA134 <br />Gal. <br />Pre Combuaiib:e Liquid, N.O.S. NA <br />t9�'3 Iii rC�ia' -tad with halo ensa <br />Cn22! <br />FiIUt/FOn2 <br />_ <br />Gal. <br />Oil & Water, Non-RCRA Hn7ardous Waste Liquid <br />Waste Solids and Sludges - <br />CA221 <br />Gal. <br />- <br />Wash Out <br />Each <br />Drained Used Oil Filteas _ _ <br />[Von-RCRA flaiardous Waste Solids (oily dchri.3) <br />CA223 a <br />Drum <br />Empty 66�� .i <br />Drum <br />�7o <br />-y <br />G.-4 0 <br />I raatspoxtatioa <br />M, ... <br />14rs. <br />Glyeol Bui 50/50 <br />_Glycoll3utk Conc. <br />Gal. <br />TEST:❑ Clor D Tech 4000 ppm U Clor D Tech 1000E] Pass ❑ Fail ❑ <br />Halogeu Detectorli"lame Test <br />❑ Pass ❑ Fail <br />z t <br />Field Service Work Description, <br />Totaf Charges <br />Other: <br />Other: <br />r <br />Vacuuni Services Time <br />Out of Yard-_,,.,-_ On Site Off Site <br />_ <br />Off Lotid Staut <br />Off Load End <br />Retttrzr to Yard <br />T'SDF ❑ Consolidated Manifest 14g <br />Oil, Inc. Evergreen Env. Svc. (—� Evergreen Env. Svc. AJS Filter ft_T6� <br />h Ave. Road 301 t..,..,J 4D9 N. Valentine El 15131 Clark Ave. <br />Newark, CA 94.560 Davis, CA 95616 Fresno, CA 93722 Industry, CA 91745 <br />CAD980887418 CAD992446874 CAD982446882 CAD000097432 <br />u Evergreen Env. Svc. ❑Evergreen Env. Svc. a CFR[:] <br />Cf--R7-7 <br />u 16604 S. San Pedro 745 A West Bcoeravia 944 E. Slauson Avc. 33210 Western <br />Carson, CA 90746 Santa Maria, CA, 93454 Los Angeles, CA 90011 Union City, CA 9458 a ley prings, 95; <br />CAD981696420 CAD982446858 CALO(101 l(X)21 CAL000091507 CALOW214411 <br />Generator certifies that it has established a program to reduce the volume or <br />Source' J Collection Station Ll Government � quantity & toxicity of [he haLardOUS waste to the. degree determined by <br />[j Marine ❑ Agricultural ® Industrial generator to be economically practicable. <br />-_- --- I herci)y certify tbat I have read and have the authrity Ler <br />o <br />bind tlteabove listed generator to the terms on the reverse <br />Retain sample #._ _ �. � side of this form. <br />IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br />Per California Health and Safety Code Section 252509, Evergreen hereby advises custoiner that custorner'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 rcyuircrncnty applicable to hazsrdous waste management facilities. California facilities that handle or process used <br />oil are required to meet those rnnre stringent requirements, and Some OUt-0f-&tate focalities that process used oil also meet those requirements. <br />Thme include more stringent leak detection and preverltinn rcquiremcnt.5, ensincering certifications of tank integrity, and financial assurances for <br />Clusut'C an(i H4(:i(LCnta1 releases. it is lawful to send used oil to out-of-state taciilvas that comply only with federal used oil man:agcrnent standards <br />and not these more strinoet t requlfements. This notitication is for information purposC:5 only. <br />& <br />