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. WORK ORD SERVICE AGREEMENT Evergreen Em�lkmental Sel1 -Ac€:,,� dedicated to the protection of the enrirnnnrent No_ 538641 To schedule a pickup, call Send paymen io: ZLI V-2` Sales Order# 800-596-9455 Evergreen Oil,Inc. . 6880 Smith Ave..Newark,CA EPA#CAD9824[3262 P.O.BOX 30217 Q 16540S.San Pedro St.,Carson.CA EPA#CAIX182413262 Los Angeles.CA 90030-0517 Date: c >-L-� rJ L f[ GENERATOR/JOB LOCATION BILLING INFORMATION NAME NAME ❑ ❑ /e CASH CHECK + ADDRESS ADDRESS r-� CUSTOMER CODE NO. : ! t,-I-1-1 ��at � )} -Tfzs l-..J 4 CITY STATE ZIP CO. CITY STATE ZIP CO. PO# PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT CODE NUMBER Q Used oil.Non-RCRA Hamrdous Lulitiuhting CA221 Ll trj,]Y ,V;a, � �►�, Gal. C t Waste.Liquid Industrial CA221 Gal. uyc[I tat hTArP1rmze.rNm4tCRA11wrdws CA134 f. ; i(3�'L�irf31t1` tr ' Gal. RQ Warm CamdNtihk E.iquM.N.OS.NA G221 1993 ut too�,��aturce�7[n t�oltr-0o2 - Gal. ` Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. Waste Solids and Sludges Gai. Wash Out Each Drained Used Oil Filters -' Drum Nan-RCRA Hazardous Waste Solids(oily debris) CA223 Drum Empty Drums Drum Transportation Hrs Non Hazardous Water Gal. Glycol Bulk 50150 Gal. Glycol Bulk Conc. Gal. TEST:❑Clor D Tech 4000---ppm ❑Clor D Tech 1000❑Pass❑Fail ❑ Halogen Detecior/Flamc Test ❑P•tss ❑Fail Field Service Work Description: Total Charges Otltet: Other- Vacuum Services Time _ - - •---r- -- Out of Yard On Site Off Site Off Load Start Off load End Return to Yard V€ E+t} k rI TS DF ❑ Consolidated Manifest I Evergreen Oil,Inc. ❑ Evergreen Env.Svc. ❑ Evergreen Em.Svc. ❑ AIS Filter ❑ < 6880 Smith Ave: Road 30B 4139 N.Valentine 15131 Clark Ave. ^Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Industry,CA 91745 CAD980887418 CAD982446874 CAD982446882 CADOM7432 i ❑ Evergreen Env.Svc. 1:1745 A West Bateravia 9Evergreen Env.Svc. ❑CFR El CFA ❑ Greenleaf Env.Svc. 16604 S.San Pedro 44 E.Slauson Ave. 33210 Westem 3474 Toyon Circle Carson.CA 90746 Santa Maria.CA 93454 Los Angeles,CA 90011 Union City.CA 94587 Valley Springs.CA 95352 CAD981696420 CAD98244M58 CAIAWI10021 CALDMI507 CAL1100214411 Source: El Collection Station Cl GOvemment Generator certifies that it has established a program to reduce the volume or quantity&toxicity of the ha»rdous waste to the degree determined by ❑Marine ❑ Agdcultural ❑ Industrial generator to be economicallypraaicable. Iveme4yoerlify that I bnYc--m-.a_4_andhave the PuthorityAo Retain sample# bind_the above listed•eenerator to the teeters on the reverse • �of thi IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. Per California Health and Safety Code Section 25150.9,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 with the more stringent requirement.-applicable to hazardous waste management facilities.California facilities that handle or process used oil are required to meet those more stringent requirements,and same out-o(--state facilities that process used oil also meet those requirements. The.-e 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 requirements.This notification is for information purposes only. L T>rivar Cinnpti[ro Drint ATmm. gn.,rn # Tti:.e., r_,,..,,..,...«•� c:,........_,, n_:_.�[,,.._„ n_._