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WORK ORDER/SERVICE AGREEMENT <br />Evercyreen Envir uental Services <br />11111111111Fli'clii'utrJ to the profCclioT of ihC em irunm ll <br />NO <br />To schedule a pickup, call Send payment to: Sales Order <br />600-596-9455 Ever,rcen oil. Inc. <br />6880 Smith Ave.. Newark, CA EPA,' CAD982413262 P.O. BOX 10517 <br />'6540 S. San Pedro St., Carson, CA EPA# CAD982413262 Los AnLcles. CA 900?0-0517 Date: 1 7--m � � - <br />ENERATOR/.JOB LOCATION BILLING INFORMATION <br />TS I4 <br />Ecerereen Oil. 1117. <br />6SS0�Smith Ace. <br />NUcaik. CA 94560 <br />CADcA08, 141 <br />IDL\u leen Enc. S\ <br />16604 S. San Pe <br />CJlson. CA 90!'6 <br />CAD9816964 ) <br />[JConsolidated Manifest <br />E\oL,rccii Enc. Scc.ElDei <br />iccn Env. S\c <br />1:1AJS <br />Flllcr <br />NAME <br />CASH❑ ChIECIi ❑ <br />i <br />tiu17)3sr Cu <br />'1STATE <br />ZIP <br />CO. <br />CITY <br />S"FATE ZIP <br />CO. <br />11ti2coD <br />l Nc.�14 <br />0E4 0 <br />PO # <br />HOVE \0, <br />,moi 3 �-Z <br />Indu tiACA 91743 <br />PHON\ <br />E O. <br />t I <br />PROFILE NO. <br />CUSTOMER LPA 11) NO. <br />�� <br />CAD000O9743_' <br />❑Ecciuicen Enc S\c. <br />❑ <br />CFR <br />PRODUCT <br />CFR <br />NVASTE <br />CODE <br />MANIFEST <br />NUMBER <br />QU:1\T1T1' UNITS <br />PRICE A1fOU'ST <br />L'sed oil. Nun-RCRA H:V:IrdUll, <br />Luhricatine <br />CA_' <br />v <br />Gal. <br />Lo; .Anadcs. CA 90011 <br />Waste. Liquid <br />Illdll,l11A <br />CA22I <br />Walley SprlllL'�. CA 1151' <br />Gal. <br />CAL006110021 <br />C.AL0(0001507 <br />CAL000114411 <br />C.I. <br />VQ AA ("" bu,ubir hq"u d.- <br />1114LIII Od :d"Ohh.a,. <br />Genuniloi ccititles that It <br />FlhlVrUltz <br />Oil S. AVater. Non-RCRA Ha!&Illltti' AVa,te <br />Liquid <br />CA?? 1 <br />Gal. <br />\Va'te Solid' and Sludges <br />Gal. <br />%Vash Out <br />Each <br />Drained Used Oil Filter <br />DRAM <br />Non-RCRA I71117a1dOn' Aretie Solid. (oily <br />dcb+i,) <br />CA 2213 <br />Dt'um <br />Empty Drums <br />Drum <br />Transporultion <br />Hrs. <br />\ <br />� \ <br />Non I'l a dour 'iter <br />Gal. <br />j <br />Erol Bulk 501,0 <br />Gal. <br />i <br />�Ivcol I Cone <br />Gal. <br />IT ST: Cloi D Tech 40111 _ppm <br />❑ Clot D Tech 100( <br />Pass ❑Fail E]Halo��en <br />Detector/Flame Tetit <br />❑ Pas❑ 1 --ail <br />Field SCI'v'll'e Work Description: <br />Touil ChtU-o('S <br />Other: <br />Other: <br />VaCnlllll 'er\ ices Tillie <br />Out ot)>'ard On Site <br />Oil Site <br />Ott Load Start <br />Oil LUad Enkl Reimn <br />to Yard <br />TS I4 <br />Ecerereen Oil. 1117. <br />6SS0�Smith Ace. <br />NUcaik. CA 94560 <br />CADcA08, 141 <br />IDL\u leen Enc. S\ <br />16604 S. San Pe <br />CJlson. CA 90!'6 <br />CAD9816964 ) <br />[JConsolidated Manifest <br />E\oL,rccii Enc. Scc.ElDei <br />iccn Env. S\c <br />1:1AJS <br />Flllcr <br />❑ <br />Ro id 3013 <br />41,() N. Valentine <br />1;1 -Clark Ace. <br />DIA1,. CA 956 16 <br />Fre,no_ CA 937'2 <br />Indu tiACA 91743 <br />CAD9h2446874 <br />G\1)9S7446,h <br />CAD000O9743_' <br />❑Ecciuicen Enc S\c. <br />❑ <br />CFR <br />❑ <br />CFR <br />Greenleaf Enc. S\c. <br />741 A \Vest Better,vis <br />944 E. SLulson Ave. <br />33310 \V'c'tern <br />3474 Toon Circle <br />S int, Mann. C•\ 91414 <br />Lo; .Anadcs. CA 90011 <br />Union Cm. CA 9487 <br />Walley SprlllL'�. CA 1151' <br />C1D983446S53 <br />CAL006110021 <br />C.AL0(0001507 <br />CAL000114411 <br />Genuniloi ccititles that It <br />ha, e'1ah1i'lled a propall) to Icdll�'e the \iT ❑m, OI" <br />SOUI'Ce: _4C011ectlon Station J Government quantity 1")& to\irity of the hazard -w, v,aste to The der:ree �ietelnlineIl by <br />Iij <br />j Marine ALI1-1CLlltural D Industrial ecll rm[ur be economically prarti.ahle. <br />— I hereby- certifi, that I ha<e read and halve the authority to <br />bind the above listed generator to the terms on the re%erse <br />Retain sample u side of this form. <br />IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br />Per California Health and Safetc Code Section 25250.9, EvcrLteen hereb%; advises cu'tomer that Customers shipment of used oil may be <br />transported to a facility that is required to comply vwith federal re Iulalion5 applicable to m.Mnt+rement of used oil. but that is not required to <br />'v with the more strillLent requirements applicable to hazardOLIS waste manaLement facilities. California fcicilities that handle or process u'ed <br />reduired 10 meet those more stl-ineent requirements. and Some out-of-state facilitieS that pn)ce,s used oil also meet those requirements. <br />include nurse sninLent le.tk detection and prevention i quiremetitS. cneineering certiiieations of milk inte"rity. and financi.,l ass�u�ances for <br />C'osure and accidental releases. It is lavyful to Send use - <br />d oil to out-of-state facilities that comply only vv-ith federal um <br />used oil anm <br />(tueent standards <br />All not these more suin��ent requirements. This notification iS f0r information purposes only. <br />I <br />