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WORK ORDUl"SERVICE AGREEMENT <br /> Evergreen EnvilAmental Services N° 5 9 3 6 2 <br /> 4 dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: <br /> 800-596-9455 sales order <br /> Evergreen Oil;Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 ^� <br /> 16540 S.San Pedro St,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: J "Z/ °'/C:) <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> N LAI q NAME CASH[-I CHECK <br /> ADD Sr # <br /> �r ADDRESS CUSTOMER CODE NO. <br /> Y (f,�ayl <br /> C STATE IF CO. CTTY STATE ZIP C. <br /> CO. PO# <br /> EN PHONE NO. PROFILE NO. - CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> 'oil,Non-RCRA Hazardous Lubricating CA22 al <br /> Waste,Liquid Industrial CA221 Gal. <br /> UV Aumommive Anufineu,Non-RCRAHmerduuv <br /> Wnaeu nid CA134 Gal. <br /> RQ Wufe Cambuuible Liquid,N.o.S.NA CA221 <br /> 1993111 Oil mnlaminvmd wia,W.ens F0011[002 Gel. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA223 Gal, <br /> Non Hazardous Water Gal <br /> Waste Solids and Sludges Gal <br /> Wash Out <br /> Each <br /> Pressure Washer/Steam Cleaner Day <br /> Transportation <br /> qFafl <br /> Fuel Surcharge % <br /> Glycol Bulk SO/ /Specify Product <br /> Glycol Bulk nc./Specify Product <br /> TEST: .Clor D Tech 4 pm Clot <br /> D Tech 1000 ass Q Fail P <br /> Retain sample# Total Charges <br /> Re wired <br /> Field Service Work Description: <br /> Other: <br /> Other. <br /> TS Consolidated Manifest DRIVER C <br /> Evergreen Oil,Inc. Evergreen Oi41nc.-Davis❑ Evergreen Oil,Inc.-Fresno ❑ Time In Time Out <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 ❑ Tank/Drum Properly Labeled <br /> CAD980887418 CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked <br /> Evergreen Env.S ❑ Ewgi=OAlna-SabMada❑ ❑ House Keeping-Tank/Dmm Clean <br /> 16604S.San P ro 745 A West Betteravia b OtherServices Checked; ❑Oil, ❑ Filters/Drums, ❑Antifreeze <br /> Carson,CA 9 46 Santa Marta,CA 93454 ❑ Called in other services needed Oil, Filters/Drums, Antifreeze <br /> CAD98169 0 CAD982446858 ❑ ❑ ❑ <br /> Source: Collection Station Generator certifies that it has established a program to reduce the volume or <br /> ❑ Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> bind the above listed generator to the terms on the reverse <br /> 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 required to comply with federal regulations applicable to management of used oil,but that is not required to <br /> comply with the more stringent requirements applicable to hazardous waste management facilities.California facilities that handle or process used <br /> oil required to meet those more stringent requirements,and some out-of-state facilities that process used oil also meet those requirements. <br /> Th include more stringent leak detection and prevention requirements,engineering certifications of to integrity,and financial assurances for <br /> clo and accidental rel ses.Itis lawful to send used oil to out-of-state facilities that comply o�wi federal used o' management standards <br /> L <br /> n t these more stringe requirements.This notification is for information purposes only. <br /> ZEm f <br /> 'eV oil <br /> D 'ver Signature Print Name Route# Date enerato s Sig ature n me Date <br />