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A WORK OKDER/SERVICE AGREEMENT �� Evergreen Environmental Services NA 3 $ $ 2 6 dedicated to the protection of the environment To schedule a pickup, call Send payment to: Sales order # ALQLe=�t 800-596-9455 Evergreen Oil, Inc. 6680 Smith Ave., Newark, CA EPA# CAD982413262 P . 130r 30517 16540 S. San Padro St., Carson, CA EPA# CAD982413262 Los Angeles, CA 90030-0517 Tate: 'Z --r b GENERATOR/JO$ LOCATION BILLING INFORMATION PRODUCT WASTE CODE NAME UNITS PRICE CASH [J CHECK ❑ Used oil, Non-RCRA Hazardous Lubricating CA22 L)54880 Smith Ave. Gal. # ADD CA221 ADDRESS Gal. C.�p CODE NO. N FM CA134 CAD9824468tt2 Gal. STA 'E Q4� CO. CITY STATE ZIP Co. Pp # PRONE NO 4}j , `, �"t PHONE NO. PROMS NO. CUSTOI ER+,EPA IQ N . Waste Scjids and Sludges Gal. Wash Out PRODUCT WASTE CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT Used oil, Non-RCRA Hazardous Lubricating CA22 L)54880 Smith Ave. Gal. 4139 N. Valentine Waste, Liquid Industrial CA221 Davis, CA 9561e Gal. CA 91745 Au (iiw AnUmem, N.,W A Fi-.d-r CA134 CAD9824468tt2 Gal. RQ Wn a ComGunbte t,lqu,d, N.O.S. NA acted Wt1G Irk1 A CA221 P001IM2 Gal_ Oil & Water, Non-RCRA Hazardous Waste Liquid CA221 Gal. Waste Scjids and Sludges Gal. Wash Out Each Drained Used Oil Filters Drum Non-RCRA Hazardous Waste Solids (oily debris) CA223 Drum Empty Drums Drum Transportation Non Hazardous Water Gal, Glycol Bulk 90150 C,al. Glycol Bulk Cont. Gal. ��jj T 3S Clor D Tech 4tll��pin ❑ Clor D Tech 1000 Pass Q Fait ❑ Halogen DetectorM- arae Test Pass ❑ Fail Picld .Service Work Description: Total Charges Other: Other_ Vacuum Services Tirne Out of Yard On Site Off Site -Off Lund S Off Load End Return to Pard 6�v,tli'1��3[,� TS F Consolidated Manifest vergrern Oil, Inc, ❑ Evergreen Env. Svc. ❑ Evergreen Env. Svc. ❑ ATS Fitter �I L)54880 Smith Ave. Road 30B 4139 N. Valentine 15131 Clark Ave. L J Newark, CA 94560 Davis, CA 9561e Fresno, CA 93722Industtryry� CA 91745 CAD99W87418 CAD982446874 CAD9824468tt2 CAD000097432 J ❑Evergreen Env, Svc,I�I Evergreen Env. Svc- ❑ CFR 1:1CFR ❑ Greenleaf Env. Svc, 16604 S. San Pedm U 745 A West Betteravra 744 E, Slauson Ave. 33210 Western 3474 Toyon Circle Carson, CA 90746 Santa Maria, CA 93454 Los Angeles, CA 90011 Union Ciryry, CA 94587 Vail Sppringgs, CA 95352 CADS 169 N CAD982446858 CALII(10I10021 CAL000091507 CAL000214411 Generator certifies that it has established a program to reduce the volume or Source: NdCollection Station D Government quantity & toxicity of the hazardous waste to the degree determined by 3rine ❑ricultural ❑ Industrial generator to be economically practicahle, 1 hereby certlDL Ihat I.have read and have the authority to C Z Cbind the above listed generator to the terms on the reverse Retain sample # side of this forth. IMPORTANT NOTICE REGARDING THE IIISPOSMON OF YOUR OIL. Per California Health and Safety Code Section 25250,9, Evergreen hereby advises customer that customer's shipment of aced oil may be transported to a facility that is required to comply with federal regulations applicable to management of used oil, but that is not required to comply with the more stringent requirements applicable to hazardous waste management facilities. California fatalities that handle or process used oil are required to meet those more stringent requirements, and some out-of-state Facilities that process used oil also [nett those requirements. These include more stringent leak detection and prcvcntion requirements, engineering certifications of tank integrity, and financial assurances for closure and accidental releases. It is lawful to send used oil to out -of -stale NCilitins that comply only with federal used oil management standards and not these Wre stringent requirements. This notification is for information purposes only.