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WORK ORDS.. 30ERVICE AGREEMENT Evergreen Environmental Services No 5 dedn aced to the prolec•tion o the envioo n ent — . To schedule a pickup,call Send payment to: Sales Order 800-596-9455 Evergreen Oil.Inc. —1-1'-Hatath A,c.,Newark.CA FPA#C'AIYII '41:_'o_' Dept.LA 23234 Po-10 S.San Pedro St..Carson,CA EPA#t Al wti,41 1'61 Pasadena,CA 91185-3234 Date: _ — GENERATOR/JOB LOCATION BILLING INFORMATION NAME, NAME CASH❑CHECK❑ l # ADDRESS ADDRESS CUSTOMER CODE NO. CIT) ti IATI: ZIP CO. CITY STATE ZIP CO. PO# t -7 7 PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE, AMOUNT CODE NUMBER Used oil,Nun-RCRA Hazardous Lubricating CA221:_ j� } r Gal. Waste,Liquid Industrial CA221 Gal. V-1 Au,q—Awf--Nan-R(R.A 11—&— CA 134 Cal. N'a•rc I n uid RQ W-w Camhu.IN,Liqu.d.N.O.S.NA C'A221 Gal. — pnc7 II I�.Od-ni-i nW tl wnh hnlu cmi F(xn/FM2 Oil 8i:Water.Non-RCRA Hazardous Waste Liquid CA223 Gal. Non Hazardous Water Gal. Waste Solids and Sludges Gal. Wash Out Each Pressure Washer/Steatn Cleaner Day Transportation Hrs. Fuel Surcharge `%c Glycol Bulk 50/50/Specik Product Gal. Glycol Bu].Vtonc./Specify Product Gal. TEST:L Clor D Tech 4(XX)—ppm ❑Clor D Tech I(XX) ❑Pass ❑Fail Retain sample# Tool Charges Required Field Sen ice Work Description: Other- Other: therOther: -i" TSDF ' Consolidated Manifest DRIVER CHECKLIST Evergreen Oil,Inc. Evergreen Oil.Inc.-Davis Evergreen Oil.Inc.-Fresno ❑ Time h) Time Out 688(.1 Smith Ave. E] Road 30B ❑ 4139 N.ValentineEJ Tank/Drum Properly Labeled Newark,CA 94560 Davis,CA 95616 Fresno.CA 93722 CAD980887418 CAD992446874 CAD982446882 ❑ Accumulation Stan Date Marked F] Evergreen Env.Svc. Eletp 0iLInc.-&mlv1:ukl ❑ House Keeping-Tank/Drum Clean 16604 S.San Pedro [:] 745 A West Betteravia y t ❑ Other Services Checked: ❑Oil, ❑ Filters/Drums. ❑Andfrce/c Carson,CA 90746 Santa Maria.CA 93454 CAD981696420 CAD982446858 10 Called in other sen ices ncedeJ p Oil, Filtrrs/Drmns.❑AntifreezeGenerator certifies that it has established a program to reduce the volume or Source: ❑Collection Station j Government quantity K toxicity of the hazardous waste to the degree determined by ❑ Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. 1 hereby certify that I have read and have the authority to bind the above listed generator to the terms on the reverse side of this form. IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. Per California Health and Safety Code Section 25250.9,Evergreen hereby advises customer that customer'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 vv-ith the more stringent requirements applicable to hazardous waste management facilities.California facilities that handle or process used oil are required to meet those more stringent requirements,and some out-Of-;tate facilities that process used oil also meet those requirements. 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 more stringent reduirements.This notification is for information purposes only. I Driver Signature Print Name Rotfte# Date Generator's Signature Print Name Date White Copy=Customer Copy-Pink&Yellow Copy--Office Use-Green Copy--Attach to manifest-Golden Copy=Driver Copy