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FROM : L.F.W. MFG. INC. FAX NO. : 209 465 6521 Mar. 09 2007 08: 3eAM P5
<br />A'P
<br />WORK ORDEPsERVICH AGRETMENT
<br />Evergreen Environmental Services �� � � � � � �
<br />dedicated to the prolectinn of the envirownen.r
<br />To schedule a pickup, call Send payment to:„ i 8 O S�1
<br />Sales Gilder tk � -Tla7(,
<br />800-596-9455 Even,
<br />rcerl (Ji1. Inc.
<br />6880 Smith Ave., Newark, CA EPA# CAD982413262 P.O. BOX .30517
<br />16540 S. San a,dro St., Carson, CA EPA# CADS82413262 Los .A,ngcics, CA 90030-051.7 Date:
<br />GENERATOR/.103 LOCATION BILLING INFORMATION
<br />NAIF ' U
<br />NAME — _...__
<br />ADDRESS
<br />CASH 0 CHECK
<br />AD RE. 5 f -
<br />S t_.�t C O
<br />Ct1STONlFR CODE NO,
<br />q
<br />C� STATUE )C1P CO.
<br />CITY STATE ZIP CO.
<br />PO #
<br />PiiONE� Nr
<br />PRONE NO_ PROFILE NC
<br />CUSTOMER EPA ID No.
<br />PRODUCT
<br />WASTE
<br />MANIFEST IQUANTITY UNITS PRICE
<br />AMOUNT
<br />Used oil. Non-RCRA Hazardous Lubricating
<br />CA221NCi
<br />Gal.
<br />crS
<br />Waste, Liquid Irlausreiai
<br />CA221
<br />Gal,
<br />uste Auromaurc A,uEfrc� �, Nu -RCR x :,n�<,uK
<br />W„rtc r: ui<I _
<br />CA134
<br />Gal.
<br />— 1
<br />RQ wasK c,>nn'u ibk r_=qu 1, N.O.S.NA
<br />1993 Itt nit 11 '1:.dnaer w t h:Jo gas
<br />AZ^1
<br />P lrl'O(Yt
<br />Gal.
<br />Oil & Mater, Non-RCRA Hazardous Waste Liquid
<br />Waste Solids and Sludge; *_
<br />CA221
<br />Gal.
<br />Gal.
<br />Wash Out
<br />Each
<br />.,. ,... .. ... _....._..._.__._.---
<br />Drained Used Qil F'ilter.9
<br />Non-RCRA Hazw-dous Waste Sgiid.3 (oily debris)
<br />C:A223
<br />---._.._......,..........,
<br />Drum
<br />Drum
<br />F..mpty .Drwns
<br />'.�,"”-
<br />._.-....�.---....., w_...._ Drum
<br />Transportation
<br />His.
<br />Non Hazardous Water
<br />Gal.
<br />Glycol Bulk 50/50
<br />! craL
<br />Glycol Bulk Conc.e��
<br />Gal,
<br />TEST:0CIoi D Tech 400U�ppcn ❑ Clue D Tcch 100 pass Fail l4alogen Detector/FlameTest ❑ Pass Fail
<br />/50
<br />Field Service Work Descriplion_�
<br />Total Charges
<br />Othen
<br />,rte
<br />Vacuum Services Time
<br />Out of Y•,v-d On Site __—_......_,_.,,Off Site Off Load Start. .. Off Load End Reurrn ro ya(d
<br />TST)F Consolidated Manifest
<br />Evei�ttien Oil, Inc, ivergrccn Lnv. $vc. Lver•rncn Em'. Svc. ❑ A35 Filter
<br />6880�Smirh Ave. Ro 30B 4139 f. Valentine 15131 Clark Ave. I—!
<br />Newark. CA 94560 Davis, 'CA 95616 Fresno, CA 93722 Industry, CA 91745
<br />CA Y)80887418 CAD982446874 CAD992440882 C'AD000097432
<br />Evergreen 13nv. Svc. Evergreen Env. Svc.❑ CFR CPR Greenleaf Env, Svc,
<br />(6604 S. San Pedro 745 A West Betteravia 944 E. Slauson Ave. 17 33210 Western 3474 Toyon Circle
<br />Carson, CA 9074.6 Santa Maria, CA 93454 Los Angeles, CA 9(x)1 I Anion City, CA 94587 Valleyy Springs, C.A. 95352
<br />CAD981696420 CAD982446858 CA! 000110021 C.AL000091507 CAL 00214411
<br />Generator certifies that it has established a program to reduce the volume or
<br />F-s-arce:O Collection Station ® (XOVerl3133ent quantity & toxicity of the hazardous waste tq the dcgr'ec determined by
<br />Marine ® Agricultural ® Industrial generator to be economically practicable,
<br />I hereby certify that I have mead and have the authority to
<br />,, hind the above listed Qeneratnr to the terms on the reverse
<br />RetSahi sa)IT pie # � � side of this form,
<br />IMPORTANT NOTICE REGARDING TECE DISPOSITION OF YOUR OIL.
<br />Per California Health and Safety Code Section 25250.9, Evergreen hervi>y advises cu5uomer that customer's shipment of used oil may be
<br />transported to a facility that is rcquimd to Comply with federal regulations applicable to management of used oil. but that is not required to
<br />comply with the more til.riTigent. rmlaircmems applicable t'Q hazardous waste management facilities. California facilities that handle or process used
<br />oil are required to meet those mora stringent. rcquirem nts, and sonic out-of-state facilities that process used oil also meet diose requirements.
<br />These include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances fix
<br />clos:urc and accidental releases. It is lawful to send used oil'm our of ::tars facilities That comply only with f4dera.l used oil management standards
<br />and not thesc mvrc st ' t requirements, This notification is for information purposes only.
<br />EAG ZC, .- e
<br />
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