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Evergreen Env�onmental ServiceesVKULt K/�r:Kv1l N AetKN LMLN 1' dedicated to the Wction of the enviranmetn ® x To schedule a pickup, call Send payment to: 00-596-9455 sales Order # 8 3 6880 Smith Ave., Newark, CA FPAIV CAD982413262 DepEvergreen Oil, Inc. LA 23234 76540 S. San PedroSL, Carson CA EP" CAD982413262 Pasadena,LCA 9 185-3234 GENERATOR/JOB LOCATION BILLING INFORMATrnly Date: t Z (Cs NA Mn .-iii- W, . W1 r PRODUCT WAS'CE MANIFEST Evergreen Oil, inc. LJ 6880 Smith Ave. CODE NUMBER QUANTITY UNITS Used oil, Non-RCRA Hazardous Lubricating 4139 N. Valentine Davis, CA 95616 e Out Waste, Liquid Industrial CA221 Cis 1. Aurora-Anu6mre. Nan -rt R aaurd ❑ E-gaenoiLhc.SaMaAtaa❑ 745 AWell Gal. nb dj. CA 134 Ii � Other Services Che&ed: o Oil, t7 FittentDrums p gnGfreeze IIt71 k(jwou<Com Liquid. N.O.S. NA CAD982446858 ('YdI. 1993 W (Oil mnmmiaeN wiN hLo x uuu uuc F946 ❑ Marine Oil & Water, Non-RCRA Hazardous Waste Liquid CA223 Gal. Non Hazardous Water practicable. Gal. Waste Solids and Sludges I hereby certify that I havered and have the authority t Gal. Wash Out brad the shore fisted generator to the terms on the reverse Gal. Pressure Washer/Rroo.., rle..__- side of flus form _ Each Fuel Surcharge - Hn. Glycol But 5 0/Specify Product % Glycol Bul nc./S pecify Product Cal. TEST: Clm D Tech 4000UP—Ppm ❑ Clor D Tech 1000 Pass Fail ❑ ❑Pass E] Fail Retain sample # Service CASH PRICE I AMOUNT j � Consolidated Manifest Evergreen Oil, inc. LJ 6880 Smith Ave. Evergreen Oi41nc. -Davis Evergreen oil, Inc. -Fresno ❑ Road 308 ❑ I� f Time In Lu Newark, CA 94560 4139 N. Valentine Davis, CA 95616 e Out CAD980887418 Fresno, CA 93722 CAD982446874 CAD982446882 0 Tank/Drum Properly Labeled Evergreen Env. Svc.. 16604 S. San Ped ❑ E-gaenoiLhc.SaMaAtaa❑ 745 AWell Cl Accumulation Stag Date Marked ❑ House Keeping - Tank/Dmm Clean Carson, CA 907 CAD9816964 Betteravia Santa Maria, CA 93454 Ii � Other Services Che&ed: o Oil, t7 FittentDrums p gnGfreeze IIt71 CAD982446858 Called in other services neededp'i O ❑ Fitrrc/Dmms❑ A of e Source: XCollection Station ❑ Gowmment Generator certifies that it has established a program to reduce the volume or ❑ Marine ❑ Agricultural L) Industrial quantity & toxicity of the hazardous waste to the degree determined by generator to be economically practicable. I hereby certify that I havered and have the authority t brad the shore fisted generator to the terms on the reverse side of flus form IMPORTANT NOTICE REGARDING THE DISPOSITION OF 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 stringent requirements, and some out-of-state facilities that process used oil also meet those requirements. se include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for ure and accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards not these more stringent requirements. This notification is for information purposes only. t s nature rent Name Route # Date Cenerator's Signature Print Name Date White tbpy=Customer Copy - Pink & Yellow Copy=office Use - Green Copy=Attach to manifest - Golden Copy=Driver Corn=