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WORK U.RVER/SERVIC E•: AGREEMENT <br />Evergreen Environmental Services <br />dedicated to the protection of the environnteni <br />To schedule_a pickup, call . <br />800-596-9455 <br />6880 SmIth Ave., Newark, CA EPA* CA6982413262 <br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 <br />Send payment to: <br />Evergreen Oil; Inc. <br />P.O. 13OX 30517 <br />Los Angeles, CA 90030-0517 <br />BILLING INFORMATTON <br />9 <br />Dater <br />PRODUCT <br />WASTE MANUTST QUANTITY <br />CODE NUMBER <br />UNITS PRICE <br />AMOUNT <br />Used oil, Non-RCRA Hazardous Lubricating <br />CA221 <br />Gal. <br />Waste, Liquid Industrial <br />CA221 <br />Gal. <br />?hrl Aa�KMuivs An�irnrae. Nem-RCRA Hawdoue <br />Wusae " old <br />CA t 34 <br />Gal. <br />Ro W.w Caob d hk Ligula. N.O. a. NA <br />11 <br />F001/P002 <br />GRI. <br />Oil 3t water, Non-RCRA Hazardous Waste Liquid <br />CA221 <br />Gal. <br />Waste Solids and Sludges <br />Gal. <br />Wash Out <br />Favh <br />Drained Used Oil Filters <br />Drum <br />Nan-RCRA Hazardews Wastc Solids (oily debris] <br />CA223 ,i' <br />Brum t <br />Empty Drums <br />Drum <br />Transpprtation <br />Hrs. <br />Non Hazardous Water <br />Gal. <br />Glycol Bulk 50/50 <br />Gal. <br />Glycol Built Conc. <br />G.J. <br />TEs,r:O Clur D Tech 40(A)____npm l for n Tech I(X)OQPaRs Fail Halogen Detector/Flame Test © Pasa ❑ Fail <br />Field Service Work Description: <br />Total Charge--, <br />Other. <br />Other: <br />Vacuum Services Time <br />Out of Yard On Site Off Site Off Load Start Off Load End <br />Return to Yard <br />TSDF <br />I-1 Evergrem Oil, Inc. ❑ Evergreen Env, Svc, <br />U 6880 Smith Ave. Road 30B <br />Newark, CA 94560 Davis, CA 95616 <br />CAD980887418 CAD982446874 <br />❑ Consolidated Mani <br />❑Evcrgrocn Env, Svc.❑ AJS Filter <br />4139N. Valentine t5131 Clark Ave <br />Fresno, CA 93722 Industry, CA 91; <br />CAD982446882 CAD000097432 <br />❑Evergreen Env, Svc, Evergreen Env. Svc, CFR CFR <br />16604 S. San Pedro E 745 A.Wcst Betteravia ❑ 944 F Slausorn Ave. D 33210 Wester <br />Carson, CA 90746 Santa Maria, CA 93454 Los Angeles, CA 90011 Union City, CA <br />CAD991696420 CAD982446858 CA1..0WII0tj21 CAL00(1091507 <br />Crenerator certifies that it has established a program to reduce the volume or <br />Source' D Collection Station ❑ Government quantity & toxicity of the ha79rdnU5 wrote to the degree determined by <br />d Marine Ll A Iieultural ❑ Industrial generator to be economically pntctieable. <br />I hereby certify that I have read and have the authority to <br />bind the above listed generator to the term on the reverse <br />Retain sample # side of this form. <br />IMPORTANT NOTICE, REGARDING THE DISPOSITION OF YOUR OIL. <br />Per California Health and Safety Code Section 25250.9, Evergirmn hereby advises customer that customer's shipment of used oil may be <br />tran.portel to a facility that is required t() wniply with federal regulations applicable 10 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 usa(1 <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 detecuun and prevention requirements, engineering certifrcatiuns of tank inlCgrity, and financial assw'anecc for <br />closure and accidental releases. It is lawful to send used oil to out -of -.tate facilities that comply only with federal used oil management standards <br />and not these more st eat requirements. This notification is for information purposes only- <br />2--)1-o2 <br />nly.2--)1-d2 <br />I� <br />