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WORK C 7ER/SERVICE AGREEME_ <br /> Eve reen Ell-Ironmental Services N° 611624 <br /> dedic ted to the protection of the environment <br /> To schE dule a pickup, call Send payment to: Sales Order# <br /> 800-596-9455 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,N ark.CA PA#C.AD982413262 Dept. LA 23234 <br /> 16540 S.San Pedro t.,Carson. 2A EPA#CAD982413262 Pasadena,CA 91185-3234 Date: �' P ZZ _I <br /> GENERATOR/ B LO ATION BILLING INFORMATION <br /> tZi NAME CASH []CHECK <br /> DRESS` # <br /> elle _ ` +4-� ADDRESS C TOMER CgDE O. <br /> CITY ST TE G ZIP CO. CITY STATE ZIP CO. PO# <br /> L' <br /> HONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA IDD NO. <br /> PR UCT WASTE MANIFEST QUANT <br /> CODE NUMBER ITY UNITS PRICE AMOUNT <br /> Used oil,Non-RCRA azardous Lubricating CA?2 xSi Gal. <br /> Waste,Liquid [nda5trial CA221 Gal. <br /> used A W W d"he Anolrc ve.N ta n-RCRA Harnn <br /> waste Li nid CAI 34 Gal <br /> RQ Was[c Cnmhualble Liquid, A.S.NA CA221 <br /> 1993 u1(oil contaminated with halogen,) F00l/F(N)2 Gal. <br /> Oil&Water,Non-RCR A Hazardot.s Waste Liquid CA223 Gal. <br /> Non Hazardous Water Gal. <br /> Waste Solids and Sludj es Gal. <br /> Wash Out Each <br /> Pressure Washer/Steam Cleaner Day <br /> Transportation Hrs. <br /> Fuel Surcharg % <br /> Glycol Bulk 0/50/Speci y Product Gal. <br /> Glycol Bu Conc./Speci y Product Gal <br /> TEST: Ctor D Tech i Ipm Clor D Tech IOW 2fPass �]Fail <br /> Retain sampl # Total Charges <br /> Required <br /> Field Service Work Des ription: <br /> Other: <br /> Other: <br /> r _ <br /> TS Consolidated Manifest <br /> DRIVU, CHECKLIST <br /> Evergreen Oil,Inc. ❑ Evell Oil,Inc.-Davis Evergreen Oil,Inc.-Fresno ❑ Time In Time Out <br /> 6880 Smith Ave. Roa 30B ❑ 4139 N.Valentine <br /> Newark,CA 94560 Dav s,CA 95616 Fresno,CA 93722 ❑ Tank/Drum Properly Labeled <br /> CAD980887418 CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked <br /> • ❑ EvergreeA90 <br /> ❑ E OiLtrc-Santablana❑ ❑ House Keeping-Tank/Drum Clean <br /> 16604 S.San 745 West Betteravia ❑ Other Services Checked: ❑Oil, ❑ Filters/Drums, ❑Antifreeze <br /> Carson, Sant Maria,CA 93454 <br /> CAD981CA 982446858 ❑ Called in other services needed ❑Oil, ❑ Filters/Drums, ❑Antifreeze <br /> Source: tion St -.ion Generator certifies that it has established a program to reduce the volume or <br /> ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑ Marin ❑ Ayncultural ❑ 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 /> IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br /> Per California Health anit Safety ode Section 25250.9,Evergreen hereby advises customer that customer's shipment of used oil may be <br /> transported to a facility tha is requir d to comply with federal regulations applicable to management of used oil,but that is not required to <br /> comply with the more strin Yent requi ements applicable to hazardous waste management facilities.California facilities that handle or process used <br /> oil are required to meet tho a more si ringent requirements,and some out-of-state facilities that process used oil also meet those requirements. <br /> These include more stringe it leak del ection and prevention requirements,engineering certifications of tank integrity,and finIncial assurances for <br /> cloy and accental rele ses. It is 1 wful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> and t these snoride stringen.require ents.This notification is for information purposes only. <br /> Iver Signature rint N Lme Route # Date Generator's Sivnature Trint Name IlatP <br />