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FROM L.F.W. MFG. INC. FAX NO. : 209 465 6521 Feb. 16 2007 11:54AN P9
<br />WOXK URDEWXVICE ACT'REEMENT
<br />Evergreen Environmental Services -1D 380"200
<br />dedie oed to the, pi?)tcIv: J,I UJ' 1lte eiIVa em ttt'nt
<br />To schedule pic:kkip, Call Send payment tot Vr4�14A2��76)
<br />COQ -596T455 I ver�reen pii, InC. Sates
<br />6680 Smith Ave., Newark, CA EPA# CAD982413262 P.0, SOX 305177
<br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Los Angeles, CA 900;30-0517 Date: (/
<br />,GENERATOR/JOB LOCATION BILLING INFO TION
<br />N JNAME
<br />d �/,%
<br />CASA (� CRECK ❑
<br />S
<br />ADDRESS
<br />T RC
<br />PO #
<br />ST T�' II' CO,
<br />CCU
<br />ITY . ,. _. SPATE ZIP CO.
<br />P N 1
<br />("HONE NO.
<br />PROFILE NO.
<br />CUSTOMER EPA 11) NOT
<br />PIcODU(-I'
<br />'WASTP
<br />CODE
<br />MANIFEST
<br />NUMBER
<br />QUANTITY UNITS PRICE
<br />AMOUNT
<br />Used oil, Nett-KPA Hazardous Lubricating
<br />CA221
<br />�
<br />Gal,
<br />Waste, Liquid industrial
<br />C'A22 3
<br />Used Auro;u7- Andrrccrc, Nw-RCRA hazardous
<br />W�
<br />CA I34
<br />Gal,
<br />RQ w Co�+bustible LlOuld, rr.Os. NAS
<br />1.?Ys Fn (Oil caiiuuuinattd with hxh,r-cnx���`
<br />CA221-
<br />F'UOI/1=Uo2
<br />(Ja1•
<br />Oil & Water, Noo'RCRA Hazarduus Waste Liquid CA221
<br />.., ,,
<br />— -- Gal,
<br />Waste Solids and Sludges . �-
<br />Ga(.
<br />Wash Out
<br />-- _ Each _
<br />Drum
<br />Drained Used Oil Filter&
<br />Non-RCRA liazat' us Waste Solids (oily debris)
<br />C:A.223
<br />Drum
<br />Empty Drums '
<br />Drum
<br />TranaportaFiot IV7.,.M.,._
<br />Hrs. -
<br />Gal.
<br />___ _._.. .. w__
<br />Non Hazardous Water
<br />Glycol Sulk _M 50/50
<br />Oral.
<br />--
<br />Glycol Boik Conc.
<br />Gal.
<br />'Total Charges
<br />TEST:7 Clor D Tech 40(10_.__p)p{r. ❑ (710,'D TCG& 1000 E] Fal ss ❑ Fail ❑ Halogen DCtECior/Flartme test ❑ Pass ❑ Fail
<br />Field setvioeyv�rk Description: n - �—
<br />_
<br />Other:
<br />_,..
<br />Other-
<br />therVacuum
<br />VacuumServices Time
<br />Out of Yard— On Site Off Site
<br />Off Load Starr
<br />Off Load End � Rctuvn Lo Yard
<br />TSDF ❑ Consolidated Manifest
<br />LEvergreen Oil, Im. n Evergreen Env, Svc, El Evergreen Cnv. Svc. F A1S Filter ❑
<br />�J 6M Smith Ave. LJ Road 30B 41_;9 N. Valentine I1 15131 Clark Ave.
<br />Newark, CA 94560 Davis, CA 95616 Ftv.sno, CA 93722 Industry, CA 91745
<br />CAD990837418 CAD982446874 CAD982446882 C;AEMZ097432
<br />Evor^sten Env. Svc, Ever-rccn Env- Svc. CFR j� CFR (—} Greenleaf Env. Svc.
<br />i66t?4 S. San Pedro 745 A West Beacmvia 944 E- Slauson Ave, E 33210 Western LJ 3474 Toyon Circle.
<br />Carson, CA 90746 Santa Maria, CA 93.454 Los AnoolosCA 90011 Union City, CA 94587 'Valley Springs, CA 95352
<br />CAD981696420 CAD9&2446858 CAL00o11562] CAL000091507 CAL(XX)214411
<br />Generator certifies that it has established a program to reduce the volume or
<br />source: ! Collection Station ® Government quantity & tuxicity of the hazardous waste to the degree determined by
<br />Marine ® Lgricultural ®Industrial generator to be economically practicable.
<br />—'�-- ' I -hereby certify that 14tave read and havethe authority to
<br />bind the above listed generator to the terms on the reverse
<br />Retain swnple # Side or this form.
<br />IMPORTANT NOTICE: REGARDING THE DISPOSITION OF YOUR OIL.
<br />Per California health and Safety Code Section 25250.9, Evergreen hercl)y advises custorner that customer's shipment of used oil may be
<br />transported to a facility that is required to comply with federal regulations applicable to m-tanagement of used oil, but that is not required to
<br />Comply with the more. ,stringent requirerneatS applicabic to hazardous waste management facilities. California facilities that handle or process used
<br />oil are required to tncet those more stringent mquimments, and some out-of-state facilities that process used oil also meet those requirements.
<br />These include more stringent leak detection and prevention requirements, cn-ineering certifications of tank integrity, and financial asswrance� l,itr
<br />closure: and accidental relcascs. It is Iawfill to send Used oil 10 ottt-oi-&tatt 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 />Driver Sipllature - Print Name Route t# batC N1:1 P liofA
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