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WORK QRDER/SERVICE AGREEMENT Evergreen Environmental Services N6 388211 dedicated to the protection of the environment To schedule a pickup, call Send payment to: Sales Order # 800-596-9455 Evergreen oil, Inc. 6880 Smfth Ave., Newark, CA EPA# CAD982413262 P.O. BOX 30517 t /� 16540 S. San Pedro St., Caraon, CA EPA# CADN12413262 Los Angeles, CA 90030-0517 Date: l GENERATORIJOB LOCATION BILLING INFORMATION NA14E 10 A NAME Manifest CASH ❑ CHECK ❑ A'0 ftESS ( Evergreen Env. ADDRF,SS 6880 Smith Avc. CUS,�O• R/ 0 ENO. SPO © yiSTA Z Co. CITY STATE, ZYP CO. ## PRONE NO. CAD980887418 PHONE NO. CAD982446882 PROFILE NO. CUSTOMER FPA ID NO PRODUCT WASTE CODE MANIFEST NUMBER QUANTITY UNITS PRICE AMOUNT Used oil, Noa-RCRA Ha2trdous Lubricating CA221 gAlGal. Waste, Liquid Industrial CA221 Gal- Us<d Auromai.ro Andf�e m Nm-RCRA H-1— "'t u ala CA l34 Gal, te Com6ustl6bttqul4 ROWT;=.=011 qr� Fl 0t1FiJ43 Gal. (hl dt Water, Non-RCRA Hazardous Wastc Liquid CA221 Gal. Waste Solids and Sludges Gal - Wash Out Each Drained Used Oil Filters Drum Non•RCRA Hazardous Waste Solids (oily debris) CA223 Arum Empty Drums Transportation. Drum Hrs. Lyon Hazardous Water Gal• Glyco18ulk S(u51) Gal. Glycol Bulk Conc. Gal. T17,S9P C1or D Tech ppm ❑ Clor D Tech 1000 s ❑ Fail ❑ Halogen DetectorMame Test ❑ Pass ❑ Fail Field Service Work Description: Total Charges Qthcr.LAC- Other Vacuum Services Time Out of Yard On Sim Off Site Off Load Stats Off Load End Return to Yard T F C nsolidated Manifest Evergreen Oil. Inc. ❑ Evergreen Env. Svc. ( Evergreen Env. 1:1A]S Filter 6880 Smith Avc. Road 30B u 4139 N. Valentine 15131 Clark Ave. Newark, CA 94560 Davis, CA 95610 Fresno, CA 93722 Industry. CA 91745 CAD980887418 CAD982446874 CAD982446882 CAD000097432 ❑ -- j� Evergreen Env. Svc. (—I Fvergrcen Friv. Svc. 1:1CFR ElCFR ❑ Greenleaf Env. Svc, tL_JJ 16604 S. San Pedro l -,J 745 A West Betteravia 944 E. Slauson Ave. 33210 Western 3474 Toyon Circle Carson, CA 90746 Santa Maria, CA 93454 Las Anggeles, CA 9(X)1 I Union City, CA 94557 Vallev S nggs, CA 953$2 CAD9 696420 CAD992446858 CAL000110021 CAL000091507 CALb00�t4411 Generator certifies that it has established a program to reduce the volume or Source ollection Station ❑ Government quantity & toxicity of the hazardous waste to the degree determined by ❑ Marine ❑ A rieultural ❑ Industrial generator to he economically practicahtc. I hereby certify that I have read and have the authority to r% bind the above listed generator W the terms on the reverse Retain sample # t/'� .. e— side of this form. -4 NT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. Per Callfornia Health and Sarety Code Section 25250.9, Evergreen hereby advises customer that customci s shipment of used 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 facilities that handle or process used oil arc required to meet those morc stringent requirements, and some out-of-state facilities that.process used oil also meet those rcquircmentc. These include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for closure and accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards and not these morc stringent requirements. Tliis notification is for information pu s only.