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5l` �Ct� 0`L w6kx 0RR/SERVICE AGREEMENT <br /> ✓� Evergreen Rental Services N° 693096 <br /> Jdedicated to the protection of the emironment <br /> To schedule a pickup,call Send payment to: Sales Order# WO L13733,> <br /> 800-972-5284 Evergreen Oil,Inc. <br /> 6880 Sndth Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: - <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> IIIE ` NAME #CASH Q CHECK❑ <br /> ADDRESSADDRESS CUSTOMER CODE N0. <br /> ^ �. <br /> L�/tio(o <br /> CI Y STA E ZIP CO. CITY STATE ZIP CO. PO# <br /> PHONE NO. PHONE NO. PROFII.E NO. - CUSTOMER EPA ID NO. _ <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA22 Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Ueed Aum VeAtft e,NMn RrltANvardoua CAI34 Gal. <br /> W u aia <br /> RQ WM Com dWe Li9ui4 NOS.NA CA221 .Gal <br /> 1993m Oil wnlaminelcd with helaen F001/10M <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA223- Gal. <br /> Non Hazardous Water Gal <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Pressure Washer/Steam Cleaner Day <br /> �- Transportation Ho. - <br /> Fuel Surcharge - % <br /> Glycol Bulk 50/Specify Product Gal. <br /> Glycol B ConcJSpecify Product Gal. <br /> TEST:[2f Clor:D Tech 4000.-/r-.ppm ❑Clor D Tech 1000 215.. ❑Fail <br /> Retain sample# Total Charges <br /> Required <br /> Field Service Work Description: <br /> Other. <br /> Other: <br /> TSD Consolidated Manifest DRIVER CHECKLIST <br /> Evergfeen Oil,Inc. ❑ EveWeen Oil,Inc.-Davis❑ Evergreen Oil,Inc.-Fresno ❑ Time In—Time Out <br /> 6880 Smith Ave. Road 30B 4139 N.Valentme ❑ Tank/Dmm PropertyLabeled <br /> Newark,CA 94560 Davis,CA 95616 - Fresno,CA 93722 <br /> CAD980887418 CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked <br /> ❑ Evergreen Env.Svc. Est�an0il,kr.-SasnMaria ❑ House Keeping-Tank/Dnim Clean <br /> 16604S San Pedro ❑ 745 A West Beneravia ❑ ❑ Other Services Checked: ❑Oil, ❑ Filters/Drums, El Antifreeze <br /> Carson, 69 42 Santa Maria,CA 93454 ❑ Called in other services needed ❑Oil, -FiltemDmms,Ei Antifreeze <br /> CAD98169642 CAD982446858 _ <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Utollection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑Marine 0 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 revers <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 /> ��omply with the more stringent requirements applicable to hazardous waste management facilities.California facilities that handle or process used <br /> .til are required to meet those more stringent requirements,and some out-of-state facilities that process used oil also meet those requirements. <br /> These include more stringent leak detection and prevention requirements,engineering ce ' cations of tank inte 'ty,and financial assurances for <br /> CIO <br /> su and accidental releases.It is lawful to send used oil to out-of-state facilities that co ply only with fed used oil management standards <br /> and these �r [ uirts: hi notification is for information purposes <br /> nver Signanlre nt Name oute# Date Ge o ' n e Date <br />