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Evergreen Environmil Services Work*6rder <br />I, dedicated to the pmteetion of the envimmnent Bill of LadAm ✓ To schedule a pickup, call AMTT95 <br />Send Payment Customer <br />800-972-5284 Evergreen Oil Inc <br />or 510-795-4400 Dept. of LA 23234 <br />6880 Smith Ave., Newark, CA EPA# CAD982413262 Pasadena, CA 91185-3234 <br />16540 S. San Pedro St., Carson, CA EPA# CAD982413262 <br />MUR&I'AgWAIR <br />2255 S AIRPORT WAY <br />STOCKTON CA 95206 <br />AMTECOL <br />Contact: <br />NOTE <br />(209) 939.1490 Ext. 0000 <br />AMTE�OL <br />810 WRIGHT AVE <br />OIL, ANTIFRZ, FILTERS ONLY <br />RICHMONDCA 94604 <br />WOC120979 <br />-- <br />T MS PURCHASE ORDER NUMBER jj7fkTERRITORY <br />TE <br />110E NO. - <br />Billgroup <br />UTE <br />PROFILE <br />PROFILE Y <br />QuantityMangest <br />llt3m-Descrfptbn <br />Na <br />unit Price <br />Amount i <br />Pkku <br />01ft"LOW <br />1 <br />NM CALLER: D <br />YEN (A.WECOL) 165 GALS,, <br />est DRIVER CHECKLIST <br />TSttDF <br />plever8nn Oil. Tw< ❑ Everprreo Oil. I.. -tar's ve. --Ft <br />7NN8. <br />L 6880 Smith Ave. Road 30a .Newuk,CA945b0 <br />Dave, CA 95616 23CAD980887418 <br />CADN2446974 <br />Evaprccn Ee.. S.c. Evergrso Oil.I.Sm \lads Test Results OOeixaa�kn CnMrap640Fb:,rinms.0/+wama <br />�16604S.Pedio 0745AWesroemsl. ❑33210W.tem rap.,.r,r, ran'.armeeaeOp.Orwcuu..manatr.am <br />PPM <br />Cbrrsop. CA 90746 S.la Meda CA93454 Union City. CA 94587 <br />.,;. CAD981696420 CAD982446858 CAL000344530 <br />Genemtm cmifiex that it has established n program to reduce the volume or <br />quantity & roaicity of the lumzdous waste to the degree dMermmcd by <br />Colleeti0q $tettnn ❑ GOVC ent <br />SOUICe: ❑ prnemtor to h economically practicable. <br />❑ Marine [] Agricultural Industrial I hereby rt'(that I h e read and h the authority <br />to • a h w. listed e t theterms the <br />Retain Sample # revers` side of this form. <br />RTANT N G THE DISPOSITION OF YOUR OIL. <br />Per California Health and Safety C on 25250.9, Evergreen hereby advises customer that customer's shipment of used oil may be transported to a facility <br />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 <br />oil me required to meet those more stringent requirements, and <br />applicable to ha rardous waste management facilities. California facilities that handle orprocess used <br />some out-of-state facilities that process used oil also meet those requirements. These include more stringent leak detection andPPrevention requirements, engineering <br />It is lawful to send used oil to out-of-state facilities that Comply only <br />certifications of tank integrity, and financial assurances for closure and accidental release. <br />-with federal used oil management standards and not these more stringent requirements. This notification is for urination purposes only. <br />� Z <br />Drive Signature PtlM Name Route # Date _ Generator's Signature Print Name � Date + <br />