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41 WORK ORDER/SERVICE AGREEMENT <br /> Evergreen EnvirOmental Services <br /> dedicated to the protection of the environment <br /> To schedule a pickup,call :�c l P,.,l ent t tiao Sates Order# C-.331 <br /> 600-596-9455 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 PP <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: 1i — <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> X&C <br /> W. NAME CASHF] CHECK <br /> # <br /> NI)DREss � ADDRESS c�T� CODE NO. <br /> ZlluCITY STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> PHO O. ?(7 <br /> E NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> 9" <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA22 1Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Automotive Antifreeze,Non-RCRA Hazardous CA134 <br /> Waste Li u". Gal. <br /> RQ waste Combustible Liquid,N.O.S.NA CA221 <br /> 1993 In(Oil contaminated with halogens) FOOIIFO02 Gal. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA223 Gal. <br /> Non Hazardous Water Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Pressure Washer/Steam Cleaner Day <br /> Transportation Hrs. <br /> Fuel Surcharge % <br /> Glycol Bulk 5990/specify Product Gal, <br /> Glycol Bul onc./Specify Product Gal. <br /> TEST. Clor D Tech 40 ppm E]Clor D Tech 1000 ass E]Fail <br /> ------------- <br /> 'Ru <br /> ----_._---_--�-__-.___- <br /> t E,(0, <br /> Field Service Work Description: r <br /> Other: <br /> Other: <br /> TS F Consolidated Manifest <br /> Evergreen Oil,Inc. � Evergreen Oil,Inc.-Davis� Evergreen Oil,Inc.-Fresno ❑ 'hi me i n t i m'.O ill <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Tall?Jl�r un F roper l .�tbc(ed <br /> CAD980887418 CAD982446874 CAD982446882 C ACCilnitllati011 5tttrt 1)aar tart ed <br /> Evergreen Env. c. Eve@=%%--SmMt &h� C litu�se <br /> I <br /> 16604 S.San P dro 745 A West Betteravia �0 Other Sc, ic�s Che kcd: ❑ Oil L1°4cl,,�i�i nul� nC <br /> All! rcezC <br /> Carson,CA 746 Santa Maria,CA 93454 <br /> CAD98169 20 CAD982446858 1Called ill others ices nceded F7(Ai_ El �D Antifreeze <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station ®Government quantity&toxicity of the hazardous waste to the degree determined by <br /> Marine Q Agricultural Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> bind the above listed generator to the terms on the reverse <br /> side of this form. <br /> PORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br /> Per California Health and Safety Code Section 25250.9,Evergreen hereby advises customer that customer'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 requirements applicable to hazardous waste management facilities.California facilities that handle or process used <br /> oil are required to meet those more stringent requirements,and some out-of-state facilities that process used oil also meet those requirements. <br /> These include more stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> ciosur nd accidental releases.It is lawful to send used oil to out-of-state facilities that comply only with federal use oil management standards <br /> and oft fhese more stringent r uirements.This notification is for information purposes only. , <br /> L r r) <br /> Dri r Signature Pnnt Name Route# Date erArs Signature Print Name Date <br />