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Sep, 9 2010 8:50AM Ca 1. West Concrete Cutting,,I::CORD 'SERVN:2487uRL'a:.,51ENT Evergreen Emiental Services dedicated to the protection ofthe envizozueent To schedule a pickup, call 800-596-9455 6880 Smith Ave., Newark, CA EPA# CAD987A 13262 16540 S. San Pedro St., Carson, CA EPA# CAD982413262 GENERATOR/JOB LOCATION Send payment to: Evergreen Oil, Inc. Ocpt. LA 23234 Pasadena, CA 91185-3234 BILLING INI/ORMATION PRODUCT WASTE II CODE I MANIFEST NUMBER Used oil, Non-PCPA Hazardous Lubricating CA22 Waste, Liquid Industrial CA221 w��'. ev`"""rrwxr"`ncan n'v'amr CA134 Oil & Water, Non-RCRA Hazardous Waste Liquid CA223 Non Hazardous Water Waste Solids and Sludges Wash Out Pressure Washer/Steam Cleaner Tzaosportstlon Fuel Surcharge Glycol Bulk 50 TM. 0 Clor D Tech 4000UP4Vm ❑ Clor D`wh 10170 Retain sample # Required Ci knead Service Work Description: Other: Other. r5 Consolidated Manifest �ergreen Oil, Inc. E1ea>bval0il, roc. -Davis Evergreen 6880 Smith Ave. ❑ Road 30B 4139 N V Newark, CA 94560 Davis, CA 95616 Prwno P CAD9808874I8 / CAD982146874 C 24< -27 u N°''5Ll79914 Sales Order;G�i��t� Date: 9" — I ?i — I u AME ADDRESS �/ DDRESS C Y STATE ONos� 41A ZIP CO. CITY RHONE NO. ` e" —11 pHOINE NO. c 1 PRODUCT WASTE II CODE I MANIFEST NUMBER Used oil, Non-PCPA Hazardous Lubricating CA22 Waste, Liquid Industrial CA221 w��'. ev`"""rrwxr"`ncan n'v'amr CA134 Oil & Water, Non-RCRA Hazardous Waste Liquid CA223 Non Hazardous Water Waste Solids and Sludges Wash Out Pressure Washer/Steam Cleaner Tzaosportstlon Fuel Surcharge Glycol Bulk 50 TM. 0 Clor D Tech 4000UP4Vm ❑ Clor D`wh 10170 Retain sample # Required Ci knead Service Work Description: Other: Other. r5 Consolidated Manifest �ergreen Oil, Inc. E1ea>bval0il, roc. -Davis Evergreen 6880 Smith Ave. ❑ Road 30B 4139 N V Newark, CA 94560 Davis, CA 95616 Prwno P CAD9808874I8 / CAD982146874 C 24< -27 u N°''5Ll79914 Sales Order;G�i��t� Date: 9" — I ?i — I u QUANTITY UNITS PRICE AMOUNT Gal. Gal. Gal. Gal. Each Hrs. Gal. Gal. ❑ Pail -Fresno ❑Time In '15me Ow p Tmk/Drum Prnperly Labeled O ACcumulalion Stan Dale hlluked ❑ Huu,e Keeping - TmkjDrum Clean Other Servitts Checked; G Oil. ❑ FOtars/Drmnv. pAirifreara �y Generator ceitities that it has cuabasbed a program to reduce the volume or Source: V Collection Station Ll Government quantity& toxicity of the hazardous Waste to ale degree determined by Q Marine Q Agricultural Q Industrial I hereby tube certify that economically T tetchy cerUN [hat 1 have read and 17aYe the authority to hlnd the above listed generator to the terns on the reverse �a oC this form IMPORTANT NOTICE REGARDING THE DISPOSITION Or YOUR OIL. Per California Health and Safety Code Section 25250.9, 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 requirements applicable to hazardous waste management facilities. California facilities that handle or process used oil are required to meet those more strini;cm requirements, and Somo out-of-state facilities that Process used oil also meet those requirements. Th nclude more stringent leak detectron and prevention requiremenR, englneering certifications of tank integrity, and financial assurances for Clos and accidental releases. Il is lawful to scud used oil roout-of--state facili[ies that comply only with federal used oil management standards and these: mora stringent rcqui menu. This mtiGcauon is for information purposes only. t r D ivet'Sianature P Name Route # Date ane r s Signature Print Na Date CASH ❑ CHECK ❑ CUSTOMS �QDE NO. STATE ZIP CO. PROFILE NO. CUSTOMER EPA ID NO. QUANTITY UNITS PRICE AMOUNT Gal. Gal. Gal. Gal. Each Hrs. Gal. Gal. ❑ Pail -Fresno ❑Time In '15me Ow p Tmk/Drum Prnperly Labeled O ACcumulalion Stan Dale hlluked ❑ Huu,e Keeping - TmkjDrum Clean Other Servitts Checked; G Oil. ❑ FOtars/Drmnv. pAirifreara �y Generator ceitities that it has cuabasbed a program to reduce the volume or Source: V Collection Station Ll Government quantity& toxicity of the hazardous Waste to ale degree determined by Q Marine Q Agricultural Q Industrial I hereby tube certify that economically T tetchy cerUN [hat 1 have read and 17aYe the authority to hlnd the above listed generator to the terns on the reverse �a oC this form IMPORTANT NOTICE REGARDING THE DISPOSITION Or YOUR OIL. Per California Health and Safety Code Section 25250.9, 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 requirements applicable to hazardous waste management facilities. California facilities that handle or process used oil are required to meet those more strini;cm requirements, and Somo out-of-state facilities that Process used oil also meet those requirements. Th nclude more stringent leak detectron and prevention requiremenR, englneering certifications of tank integrity, and financial assurances for Clos and accidental releases. Il is lawful to scud used oil roout-of--state facili[ies that comply only with federal used oil management standards and these: mora stringent rcqui menu. This mtiGcauon is for information purposes only. t r D ivet'Sianature P Name Route # Date ane r s Signature Print Na Date