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�.... AWORK ORDER/SERVICE AGREEMENT
<br />"= AEvergreen Environmental Services N° 390213
<br />A dedicated to the protection of the environment
<br />To schedule a pickup, call Send payment to: Safes Order #
<br />800-596-9455 Evergreen Oil, Inc.
<br />6880 Smith Ave., Newark, CA EPA* CA0982413262 P -a, BOX 30517
<br />16540 S. San Pedro St., Carson, CA EPA# QAp982413262 Los Angeles, CA 9d030-0517 Date: -_32
<br />GENERATORIJOB LOCATION BILLING INFORMATION
<br />A
<br />WAS'T'E
<br />CODE
<br />NAME
<br />QUANTITY UNITS PRICE
<br />CASH ❑ CHECK ❑
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<br />t 'L
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<br />4
<br />Ev reen Oil, Inc.
<br />688(�Smith Ave,
<br />Gal,
<br />Ever Env. Svc.
<br />4139N.Valcntine
<br />�-
<br />CA221
<br />Davis, CA 95616
<br />Gal.
<br />#
<br />ADDRESS
<br />CA 134
<br />ADDRESS
<br />tial_
<br />(UVOMER CODE NO.
<br />RAZ Waste CombusGbk L114 N.0.5. NA
<br />cm3 rn 1 n e
<br />C.A221
<br />F0011R]D2
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<br />criT STATE
<br />ZIP CO.
<br />CITY
<br />STATE ZIP CO.
<br />PO #
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<br />Gal.
<br />PHONE NO.
<br />PHONE NO.
<br />Each
<br />PROFILE NO.
<br />CUSTOMER EPA ID N0,
<br />g is
<br />Drum
<br />Non-RCRA Hazardous Waste Solids (oily debris)
<br />CA223
<br />PRODUCT
<br />WAS'T'E
<br />CODE
<br />MANIFEST
<br />NUMBER
<br />QUANTITY UNITS PRICE
<br />AMO[INT
<br />Used oil, Non-RCRA Hazardous Lubricating
<br />CA22
<br />Ev reen Oil, Inc.
<br />688(�Smith Ave,
<br />Gal,
<br />Ever Env. Svc.
<br />4139N.Valcntine
<br />Waste, Liquid Industrial
<br />CA221
<br />Davis, CA 95616
<br />Gal.
<br />industtryry CA 91745
<br />Uud As-MQUve Aiuif—C, N—RCRA Hazardous
<br />waete [:
<br />CA 134
<br />CAD982446882
<br />tial_
<br />RAZ Waste CombusGbk L114 N.0.5. NA
<br />cm3 rn 1 n e
<br />C.A221
<br />F0011R]D2
<br />Gal.
<br />Oil A Water, Non-RCRA Hazardous Waste Liquid
<br />CA221
<br />Gal.
<br />Waste Solids and Sludges
<br />Gal.
<br />Wash Out
<br />Each
<br />lhwned Used Oil Filters
<br />Drum
<br />Non-RCRA Hazardous Waste Solids (oily debris)
<br />CA223
<br />Drum
<br />Empty Drums
<br />Drum
<br />Transportation
<br />Hrs.
<br />Non Haztudotm ter
<br />Gal.
<br />Glycol Bulk 50150
<br />Gal.
<br />Glycol Bu Cone,
<br />Gal.
<br />TEST: Clor D Tech 4(W_&a4pm ❑ Clor D Tech 1000
<br />6ass ❑ Fail ©
<br />Halogen Detector/Rfamc Test ❑ Pass Pail
<br />Feld Service Work Description:
<br />Total Charges
<br />Other.
<br />Other.
<br />Vacuum So Ices Time
<br />Out of _ OU Site Off Site
<br />oti' Load Stott
<br />Off Lewd End Rtxurn to
<br />`
<br />❑Evergreen Env, c, ❑ Evergeen Env. Svc. ❑ CFR ❑ CFR ❑ 34 e Toy n Circle
<br />16604 S. San 745 A ~vest Beacravia 944 E. Slauson Ave. 33210 Western
<br />Carron, CA 4( Santo Maria, CA 93454 Los Angcies, CA 9001 t Union City, CA 94587 Valley Springs, CA 95352
<br />CAD9816 20 CAD9824t6858 CAUIOt1110021 CAUOX)91507 CAL000214411
<br />Generator certifies that it has established a program to reduce the volume or
<br />Source: Ch Collection Station ❑ Government quantity & toxicity of the ha7,4rdous waste to the degree determined by
<br />❑ Marine ❑ Agricultural 0 Industrial generator to be economically practicable.
<br />D hereby certify that I have read and have the authority to
<br />/ bind the above listed generator to the terms 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, Evergreen hereby advises customer that customer's shipment of used oil may be
<br />transported to a facility that is rcduirod to comply with federal regulations applicable to management of used oil, but that is not "uired to
<br />cumply with the more stringent requirements applicable to hazardous waste management facilities. Califomia facilities that handle or process used
<br />oil are required to meet thosc more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements.
<br />nesc include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for
<br />clo. and occidental rele-ascs. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standard,
<br />an n t these mare stringent rcyu,mmcnts_ This notification is for information purposes only-
<br />C11,41—
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<br />Consolidated
<br />Manifest
<br />Ev reen Oil, Inc.
<br />688(�Smith Ave,
<br />E green Env. Svc.
<br />usd 3(fH
<br />Ever Env. Svc.
<br />4139N.Valcntine
<br />AJS Filter
<br />❑ 15131 Clark Ave.
<br />Newark, CA 94561)
<br />Davis, CA 95616
<br />Fresno, CA 93722
<br />industtryry CA 91745
<br />CAD980887418
<br />CAD9H244h874
<br />CAD982446882
<br />CAD000(197432
<br />❑Evergreen Env, c, ❑ Evergeen Env. Svc. ❑ CFR ❑ CFR ❑ 34 e Toy n Circle
<br />16604 S. San 745 A ~vest Beacravia 944 E. Slauson Ave. 33210 Western
<br />Carron, CA 4( Santo Maria, CA 93454 Los Angcies, CA 9001 t Union City, CA 94587 Valley Springs, CA 95352
<br />CAD9816 20 CAD9824t6858 CAUIOt1110021 CAUOX)91507 CAL000214411
<br />Generator certifies that it has established a program to reduce the volume or
<br />Source: Ch Collection Station ❑ Government quantity & toxicity of the ha7,4rdous waste to the degree determined by
<br />❑ Marine ❑ Agricultural 0 Industrial generator to be economically practicable.
<br />D hereby certify that I have read and have the authority to
<br />/ bind the above listed generator to the terms 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, Evergreen hereby advises customer that customer's shipment of used oil may be
<br />transported to a facility that is rcduirod to comply with federal regulations applicable to management of used oil, but that is not "uired to
<br />cumply with the more stringent requirements applicable to hazardous waste management facilities. Califomia facilities that handle or process used
<br />oil are required to meet thosc more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements.
<br />nesc include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for
<br />clo. and occidental rele-ascs. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standard,
<br />an n t these mare stringent rcyu,mmcnts_ This notification is for information purposes only-
<br />C11,41—
<br />nly.C1y /
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