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WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Envi�nrnental Services No A , 1 <br /> " dedicated to the pro tion of the enntronment -. i" <br /> To schedule a pickup, call Send payment to: <br /> Sales Order <br /> 800-596-9455 Evergreen Gil, Inc. <br /> 6880 Smith Ave., Newark, CA EPA#CAD982413262 P.O. BOX 30517 <br /> 16540 S.San Pedro St,Carson, CA EPA#CAD982413262 Los Angeles, CA 90030-0517 Date: -Z(o -:ti:7 <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> ANA , 1 \ NAME I#CASH❑CHECK❑ <br /> A DRESS r s ADDRESS CUS OMER CODE NO. <br /> CITY STATE ZIP CO. CrrY STATE ZIP CO. PO# <br /> PHONE NO, PHONE NO. PROFILE NO. CUSTOMER EPA ID N0: <br /> rAl 1%4 <br /> PRODUCT WASTE MANIFEST <br /> CODE NUQUANTIUNITSQUANTY UNITS PRICE AMOUNT <br /> Used oil,Non-RCRA Hazardous Lubricating CA22 Z-1h Gal. .�O <br /> Waste,Liquid Industrial CA221 Gal.. <br /> ❑ud Amonm,ire Andf.e NUPRCRA H.eveaas CA134 Gal. <br /> Wus¢L,uitl <br /> RQ{Yale Combuvible Liquid N.OS.NA =1 Ga] <br /> 1993 111 Oil eonmmiouud will,hWo ens FmUI/FU02 <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Drained Used Oil Filters Drum <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum <br /> Empty Drums Drum <br /> Transportation Hrs. <br /> Non Hazardous Viater Gal. <br /> Glycol Bulk 50/50 7 - Gal. <br /> Glycol Bul Cone. '" Gal. <br /> TEST: Clor D Tech 4W(J&f._ppm ❑Or,D Tech 1000 , Pass ❑Fail ❑ Halogen DetectinfHame TA ❑V110, <br /> Feld Service Work Description:Other: <br /> Other: <br /> Vacuum rvices Time fE <br /> On Site Off Site_Off LoadStrt Off Load End R urn t <br /> Consolidated Manifest <br /> Oil,Inc. Evergreen Env.Svc. Evergreen Env. Svc, <br /> AJS Filter <br /> dr Ave. 1:1 Road 30B1:1 4139 N.Valentine 15131 Clark Ave. <br /> Newark.CA 94560 Davis,CA 95616 Fresno,CA 93722 Industrtryy -A 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CADO '0'97432 <br /> Evergreen Env.Svc. Evergreen Env.Svc. /C-A'L000 <br /> CFR Greenleaf Env.Svc. <br /> 16604 S.San Pedro 745 A West Bettemvia1:1E.Slauson Ave. El 33210 Western 3474 Toyon Circle <br /> Carson,CA 90746 Santa Maria,CA 93454Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696420 CAD982446858 110021CAL000091507 CAL000214411 <br /> Source: ❑ Collection Station ❑GO ritment Generator certifies that it has established a program to reduce the volume or <br /> quaedty&toxicity of the hazardous waste to the degree determined by <br /> D Marine ❑ Agricultural Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> Retain sample # 14 t= t bind the above listed generator to the terms on the reverse <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 /> comply with the more stringent requirements applicable to hazardous waste management facilities. California facilities that handle or process used <br /> oil 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 certifications of tank integrity,andfinancial assurances for <br /> osure and accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> not these more stringent requirements. This notification is for information purposes only. <br /> river5i¢nature Print Name Route # Date enerator's Si man re Print Name Parr <br />