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�A06 WORK ORDER/SERVICE AGREEMENT J Evergreen Envimental Services .� •dedieated to the pm tion of the environment 37 401 schedule a pickup, call nd rm ,t.rl its; Sales Order # 800-596-9455 Evergreen On; Inc. 6880 Smith Ave., Newark, CA EPA#CAD982413262 P.O. BOX 30217 16540 & San Pedro Si, Carson, CA EP" CAD982413262 Los Angeles, CA 90030-0517 Date: GENERATORIJOB LOCATION RIFUT rnlr_ rnrr-nUXXA� NAME NAME V Evergreen Oil, Inc.ElRoad 6880. Smith Ave. Newark CA 94560 CAD980887418 Evergreen Env. Svc. 30B Davis, CA 95616 CAD982446874 ❑ Evergreen Env. Svc. 4139 N. Valentine Fresno, CA 93722 CAD982446882 Filter ❑ El 15131 15131 Clark Ave. Industry, CA 91745 CAD000097432 CASH Q CHECKEI ADDRESS ADDRESS # CUSTOMER CODE NO. CITY STATE ZIP CO. CITY STATE ZIP CO. PO# PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. ( ( ) PRODUCT WASTE MANIFEST QUANTITY CODE NUMBER UNITS PRICE AMOUNT Used oil, Non-RCRA Hazardous Lubricating CA221.- Gal Waste, Liquid Industrial CA221 Gal wAurmvorrve Avufma<xm,-Rcwva,:„aq,,,CA134 RQ Wove Combustible Liqui0. N.OS.\A lays nrlal�w,,;omea,„m nfl CA221 Fanlna02 Gal: Gal. Oil & Water. Non-RCRA Hazardous Waste Liquid CA221 Gal Waste Solids and Sludges Gal Wash Out _ Each Drained Used oil Filters Dram Non-RCRA Hazardous Waste Solids (oily debris) CA223 Drum Empty Drums Drum Transportation firs. Non Hazardous Water Gal. Glycol Bulk 50/50 Gal. Glycol Bulk Cone. Gal TEST: ❑ Clor D Tech 4000_ppm Q Clor D Tecb 10000 Pass Q Fail Q Halogen DetectodFlame Test E Pass Fail Field Service Work Description: Other: Other. Vacuum Services Tune - Out of Yard On.Site Off Site _Off Load Start Off Load End —Return to Yard TSDF ❑ Consolidated Manifest Evergreen Oil, Inc.ElRoad 6880. Smith Ave. Newark CA 94560 CAD980887418 Evergreen Env. Svc. 30B Davis, CA 95616 CAD982446874 ❑ Evergreen Env. Svc. 4139 N. Valentine Fresno, CA 93722 CAD982446882 Filter ❑ El 15131 15131 Clark Ave. Industry, CA 91745 CAD000097432 ❑ Evergreen Env. Svc.1:1Evergreen Env. Svc. ❑ CFR ❑ CFR ❑ Greenleaf Env. Svc. 16604 S. San Pedro 745 A West Beaeravia 944 E. Slauson Ave. 33210 Western 3474 Toyon Circle Carson..CA 90746 Santa Maria, CA 93454 Los Angeles, CA 90011 Union City, CA 94587 Valley Springs, CA 95352 CAD981696420 CAD982446858 CALOOOII0021 CAL000091507 CAL000214411 Source: ❑ Collection Station ❑ Government I Generator certifies that it has established a program to reduce the volume or quantity & toxicity of the hazardous waste to the degree determined by generator n, be economically practicable. Ll Mal1De C3 Agricultural C] Industrial I hereby certify that have read and have the authority to bind the above listed generator to the terms on the reverse Retain sample # side of this form. IMPORTANT NOTICE REGARDING THE DISPOSITION OFYOUA OIL. Per California Health and Safety Code Section 25250.9, Evergreen hereby advises customer that customer's shipment of usedoil 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. These 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-statefacilities that comply only with federal used oil. management standards and not these more stringent requirements. This notification is for information purposes only.. Driver Sienature Print Name Route # Date Generator's Signature Print Name Date