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WORK ORDER/SERVICE AGREEMENT
<br />Evergreen Enviii mental Services � N0 353493
<br />Jrdi(aled to flit, prutt�vP tun ui tht� "n0rnnu'
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<br />../� To schedule a pickup, call Send payment to:0 Sales e #� ��✓
<br />800-596-9455 Evergreen Oil. Inc.
<br />6880 Smith Ave.. Newark. CA EPA# CAD982413262 P.O. BOX 30517
<br />'6540 S. San Pedro St., Carson, CA EPA# CAD982413262 Lott Angeles. CA 90.030-05 17 Date.
<br />ENER•1TOR/JOB LOCATION BILLING I ' RMATION
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<br />CASH ❑ CHECK ❑
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<br />CA221
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<br />ADDRESS
<br />C:\'_'I
<br />F061(rll,
<br />CU M- C D
<br />Oil l \Viler. Non-RCRA hazardous Waste Liquid
<br />CA221
<br />Gal.
<br />Waste Solids and Sludges
<br />CITY /��, NATE
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<br />CIT('
<br />STATE ZIP CO.
<br />I'O #
<br />PH04E,W.7 7
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<br />PHONE NO.
<br />CA?_'3
<br />PROFILE NO.
<br />CUS'r0\ILR EPA ID NO.
<br />Drum
<br />Transportation
<br />Hrs.
<br />N!,- u-,,, t„tt< \V: I,,,
<br />G%
<br />PRODUCT
<br />WASTE
<br />WASTE
<br />MANIFEST
<br />NUMBER QUANTITYUNITS PRICE AMOUNT
<br />Used oil. Non-RCRA Hazardoils Lllbi"Ballo`
<br />CA_'_'1
<br />Gal.
<br />Waste. Liyuid Industrial
<br />CA221
<br />Gal.
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<br />CA 134
<br />Gal.
<br />lit) K:nlc CInrhu'10,1, Liqu W.'.(1S \A
<br />1441 III �f1ii .��rt:tn d I, th h: 'Iern„
<br />C:\'_'I
<br />F061(rll,
<br />Gal.
<br />Oil l \Viler. Non-RCRA hazardous Waste Liquid
<br />CA221
<br />Gal.
<br />Waste Solids and Sludges
<br />Gal.
<br />Nash Out
<br />Each z
<br />Drained Used Oil Filters
<br />Drum
<br />Non-RCRA Hazardous \\%me Solids (oily debris)
<br />CA?_'3
<br />Drum
<br />Empp Drums
<br />Drum
<br />Transportation
<br />Hrs.
<br />N!,- u-,,, t„tt< \V: I,,,
<br />Gal.
<br />lNeol Bulk 50/50 I I __- Gal.
<br />61\rol Bulk Cone. I Gal.
<br />TEST:❑ Clor D Tech 4000 pilin ❑ Got D Tech 1000❑ Pass ❑ Fail ❑ Halogen Detector/Flame Test ❑ Pass ❑ Fail
<br />Field Service Work Description: — Total C�1111'?CS
<br />Other:
<br />Other:
<br />VaCUL1111 Ser\ices Time
<br />Out of Turd On Site Off Ske Off Load Start OI1' Load End Return to Ytnd
<br />TSDF ❑ Consolidated Manifest
<br />7
<br />❑lner�'reen Oil. Inc. ❑ L-�ergreen Env. SvC. ❑ Even-neen Enc. Svc.El,11S Filler ❑
<br />6.181) Smith Aae, Road 30B 4139 N. Valentine 15131 Clark Ace.
<br />Nevuak. CA 94560 Dais. CA 9W6 Fresno. CA 93711 lndustrv, CA 91745
<br />CAD9S088741 S CAD9S1446S74 C.AD981446 S1 CAD06009743'
<br />❑E\erLreen En\. S\e. ❑ E\u_recn Em S\c. ❑ CFR CFR ❑ Gteuflkat Em. S\l:
<br />166(4 S. San Pedro /45 A West Bettuno is 944 E.Slar,on AN13110 Western 3474 Toyon Circle
<br />Carson. CA 907-36 Sanlu Marna. CA 013454 Lu; .AnLeles. CA 510011 Union CitvT. CA 94357 Valley Springs. CA 953.51
<br />CAD(181696420 CAD91144W8 CAL011(11100'_1 CA1_00(61 07 CAL000214TII
<br />Generator Certifies that it has est Ihltshed a In'o�tam in reduce the vtlumc ur .
<br />SOUrce: IJ Collection Station Government yu;uwty Sc to Ca of th\ hazardous \\a>te to the de ree doermincd h\
<br />Marine ® A21-lCLllttll'11 ij IndUstrlal _enerttor to be economicall,, pia wahle.
<br />I hereby certify- that I halve read and ha\e the authoritk to
<br />bind the above listed generator to the terms on the re\erse
<br />Retail) sample # side of this form.
<br />IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL.
<br />Per California Health and Safety Code Section 2250.9, Evergreen hereby advises Customer that customer S Shipment of usecl oil rna� be
<br />trulsported to a facility that is required to Comply vyith federal regulations applicable to management of used oil, but that is not required to
<br />,ly vv'ith the more stringent requirenlent5 applicable to hazardouS vyaste management facilities. California facilities that handle or process used
<br />required to meet those nxe'e stringent requirements. and some out-of-state facilities that process used oil also meet those requirements.
<br />.,e include more stringent leak detection and prevention reyuirenlents, engineering certifications of tank integrity. and financial assurances lot -
<br />closure and accidental releases. It is la\\ful to send used oil to oto -of -State facilities that comply only \vith federal used oil management standards
<br />and not these more stinE!ent requirements. This notification is for information purposeS only.
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