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J <br /> WORK,O SERVICE AGREEMENT <br /> Evergreen EnAnmental Services N° 693103 <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: Sales Order# 37jA <br /> �\ 800-972-5284 Evergreen Oil,Inc. <br /> 6880 smith Ave.,Newark CA PPA#CAD982413262 Dept.LA.23234 <br /> 16540 S.San Pedro St.,Carson,CA EP"CAD982413262 Pasadena,CA 91185-3234 Date: . �/ 7 <br /> GENERATOR/JOBLOCATION BELLING INFORMATION <br /> NA NAME CASH-❑CHECK E) <br /> �� # <br /> ADDe SSe' Q� ADDRESS CUSTOME 'COD . <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA.ED NO. <br /> ",L— ( ) I i24LbW15*75ft, <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> UwlAummotiw Amifts Non.RCRAnet .d CA13 Gal. <br /> Wmtt W and <br /> so W—Combutliac Liq,iq N.O.S.NA CAM Gal. <br /> rsssm oa ronumm..wfM W. F0011M <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 /> I <br /> Transportation Hrs. <br /> Fuel Surcharge % <br /> Glycol Bulk50/50/Specify Product Gal. <br /> Glycol Bulk ConcJSpecify Product Gal. <br /> TEST:p Clor D Tech 4000—ppm ❑Clor D Tech 1000 Pass ❑Fail <br /> Retain sample# Total Char es <br /> Required L <br /> Field Service Work Description: <br /> Other: <br /> Other. <br /> TS5F Consolidated Manifest DRIVER CHECI <br /> rLrJr Evergreen Oil,Inc. ❑ Evergreen Oil,Inc.-Davis Evergreen Oil,Inc.-Fresno ❑ Time In Time Out <br /> 6880 Smith Ave. Road 30B 4139 N.Velenttne p.Tank/Drum Properly Labeled <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 <br /> CAD990887418 CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked _ <br /> ❑ Evergreen Env.Svc. Ete�mmOl,Irc.-SaMaM�a❑ ❑ House Keeping-Tank/Drum Clean <br /> 16604 S.San Pedro 74 A West Bettemvia ❑ Other Services Checked: ❑ Oil, ❑ Filters/Drums, O Antifreeze <br /> Carson,CA 90746 Santa Maria,CA 93454 0 Called in other services needed E3 Oil, Filters/Drums,[3Antifreeze <br /> CAD9816964 Q CAD982446858 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑Marine ❑ Agricultural ❑ Industrial generator to be economically pract cable. <br /> II hey gcdfy that I have read and have the authority to <br /> bind the above listed generator to the termson the reverse <br /> side of this form. <br /> IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OH,. <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 /> ��mply with the more stringent requirements applicable to hazardous waste management facilities.California facilities that handle or process used <br /> ail are required tomeet[hose more stringent requirements,and some out-of-state facilities at process used oil also meet those requirements. <br /> These' crude more stringent leak detection and prevention requirements,engineering ce a'ons of to tegrity,and financial assurances for <br /> closur d accidental releases.Itis lawful to send used oil[o out-of-state facilities that c ly only wi rad used oil management standards <br /> and n these more stringent requirements.This notification is for information purposes o <br /> D ' er Signature nt Name Route# Date netat r s to 150t Name Date <br />