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05/23/2011 HON 15: 56 PAX 209 467 1124 Elaakmun Equipment f�J015/029 <br /> - WORK ORI)IMil -ERVICE AGREEMENT <br /> Evergreen Env <br /> il hmental Services No 622728 <br /> drefinrled fo rhe proleclinn of the envitol jenl <br /> To schedule a pickup,call Send payment to: Z�e�Z <br /> 800-596-9455 Evergreen Oil.Inc. Sales Order# �� <br /> 6880Smirh Avc.,NCWurk.CA CPAFCAD9%'2d157,62 Dept.LA 23234 <br /> 16.540 S.San 1',x1m 8L,Corson.CA 14PA4 CAD982413262 Pasadena.CA 91185-3234 Date:�. . <br /> GF,NERATOR/JOB LOCATION BHddNG INFORMATION <br /> TE ` NAME CASK[�CHECK❑ <br /> ?' A <br /> ADDRESS ADDRESS C TQhTfiR CODE NO. <br /> e Oz. <br /> LI Yti ATF. <br /> ZIP <br /> CO- CITY STATE. 'Lll• CO. 1' # <br /> C9n `fir 7 _ <br /> PHONE NO. PHONE NU. - PROFB.I?NO. CUSTOMER EPA ID NO. <br /> 7- Int ( I L xoom 1�j <br /> PRODUC-r WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Used oil.Nun-RCRA Harnrdous Lubricating e Gal. <br /> Writs,Liquid ludusltial CA221 Gal. <br /> OfNAurouwN¢Am,fuw..NVn.RQRA Inivaem ' <br /> RQ W.W C CAll Gal. <br /> RQ Vl wit N.rot.N C.. <br /> I Iwllll eil mueniiiuovl.ilh halo n¢I virll/FU@ CAI. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA223 Gal. <br /> i <br /> Non Hazardous Water Gal <br /> Wow solids rani Sludges tel, <br /> s <br /> Wash Out Each <br /> Preasurc Wasbcr/Swam Clcuner Day <br /> Trun.sporutian Ata. <br /> Fuel Surcharge % <br /> Glycol Bulk SNS lfy Product Gal. <br /> Glycol Bulk eJSpecify Product <br /> TEST:ZC11,DT h4(XXL-loppm E3actD Tech l(IW Rue QF:lil <br /> Retain sample AQ To hatres <br /> Requiredp a� <br /> Field Servic0 Work Debimplion: <br /> Other. <br /> Ogg ' <br /> I <br /> fel lva�" <br /> TSFA Consolidated Manifest DRIVER CKT 1ST <br /> Evergreen Oil,Inc. ❑ E�Oil,Im•Dave Evrsgreta Oil,Inc.-Fresno prune In 'time Out <br /> G880 Slvilh Ave. Road 30D 4139 N.Valentine <br /> Newark,CA 94560 Davis,CA 95616 Fresno.CA 9.4722 0 Tarlk/Dmm Property Labeled <br /> CM3980887418 CAD982446874 CAU982446892 Cl Accumulation SLVI Date Muked ' <br /> Evergreen Env.Svc- 0 Hnusc Keeping-Tunk/Dmm Clean I <br /> 166th[S-San Ped 745 A West Bettemvia 0 Odes Services Checkcd: ❑ Oil. 0 I-iln:rN/Dmins, Ch Autifrcmc <br /> CusI1n.CA 9(17 Santa.Mada,CA 93454 <br /> CAD96169 CAD982446858 C3 Called in other scrvicea needed❑Oil. Fillers/Drumx,❑ANiLCeze <br /> Source: Collection Station' ❑Government quantity <br /> mnifiea that it has established a program to reduce the volume or <br /> quantity&luaicity of the hazmdoas Waste to the degree deremtined by <br /> ❑Marine U Agricultural ❑ Industrial gencralor to be ecalomically practicable. <br /> I hereby -crU y that I have mad and havethe authority to <br /> in e,above listed na orator to the terms on lhe•reverse <br /> side of this fntm- <br /> IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. i <br /> Per California Health and Safety Code Smtton 25250.9,kiwrgrmu hereby advises customer that cusRlmtx s shipment of used oil may be <br /> transported t0 a facility that is required to comply with rWcral regulation applicable to management of used oil,bol Ihat is not required to <br /> comply with the more stringent requirements applicable to hazardous waste managemem facilites_California facilities that handle or proccas used <br /> oil are required to meet thane more stringent requirements,rind some our-ofslatc facilities that process used oil also meet those requirements. <br /> •se inclndc more stringent leak detection and prevention requirements,engineering certifications M'lame integrity,and financial assurances for <br /> cl ore and ac <br /> e <br /> id <br /> cn[al rcleams.Itis lawful to send used oil to outof-stale facilites that comply only with federal o5ed oil management slundards <br /> lot:these more strnhgen requirement. .This notification is for infomtation'purpuscs only. <br /> er Signature t Name Route# Date G nerator's Signature Print Name Date <br /> White Copy=Customer Copy-pink&Yellow Copy-Office Use-Green Copy=Attach to manifest-Golden Copy--Driver Copy <br />