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j WORK ORDER/SERVICE AGREEMENT <br />U . Evergreen Envi*mental Selwaces � No 544175 <br />dedicated to the yrofecrion of the environment <br />To schedule a pickup, call Send payment to: Sales Order # <br />800-596-9455 Evergreen Oil, Inc. <br />6880 Smidr Ave., Newark, CA EPA# CAD982413262 Dept: LA 23234 <br />16540 S. San Pedro St, Carson, CA EPA# CAD982413262 Pasadena, CA 91185-3234 Date: •'' G ?? <br />,' Zj 1: 1 <br />GENERATORIJOB LOCATION BILLING INFORMATION i <br />e <br />NAME <br />Consolidated Manifest <br />NAME <br />Evergreen Oil, Inc. <br />6880 Smith Ave. <br />Evergreen Oil, Inc. - Davis Evergreen Oil, Inc. - Fmsn <br />❑Road 30B ❑ <br />CASH ❑ CHECK ❑ <br />�, <br />Newark, CA 94560 <br />4139 N. Valentine <br />Davis, CA 95616 Fresno, CA 93722 <br />Tank/Drum Properly Labeled <br />CAD980887418 <br />CAD982446874 CAD982446882 <br /># <br />ADDRESS <br />❑ Eraaeengl, Inc-SauaMaia❑ <br />ADDRESS <br />16604 S. San Pedro <br />Carson, CA 90746 <br />745 A West Betteravia <br />Santa Maria, CA 93454 <br />CUSTOMER CODE NO. <br />CAD981696420 <br />CAD982446858 <br />0 Called in other services needed 0 Oil, 0 Filters/ ins, 0 Antifre <br />Source: ❑ Collection StationGenerator <br />❑ Government <br />certifies that it has established a program to reduce the volume or <br />Tc Ab <br />STATE ZIP <br />fir- �` '7 ('�=-�' <br />. CO. <br />CITY STATE. <br />Zip <br />CO. <br />PO # <br />O. <br />bind the above listed venerator to the terms on the reverse <br />'PHO NO. <br />side of this form <br />PHONE NO. <br />PROFILE NO. <br />CUSTOMER EPA ID NO. <br />PRODUCT <br />WASTE <br />CODE <br />MANIFEST QUANTITY <br />NUMBER <br />UNITS <br />PRICE <br />A I OUNT <br />[Uscjdi]j,Nojn-RjCRjAHazardouNon-RCRA Hazardous Lubricating <br />CA22 <br />- (;f5bu <br />Gal. <br />quid Industrial <br />CA221 <br />- <br />Gal. <br />ljve Antifinem,Nan-RCRA H:vardarsGA134 <br />Gal. <br />mbugibk Liquid, NO.S. NA <br />wish W. ens) <br />CAZycomaminmed <br />E1101/Fn02 <br />Gal. <br />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />CA223 <br />Gal. <br />Non Hazardous Water <br />Gal. <br />Waste Solids and Sludges <br />Gal. <br />Wash Out <br />Each <br />Pressure Washer/Steam Cleaner <br />Day <br />Transportation <br />Hrs. <br />Fuel Surcharge <br />% <br />Glycol Bulk 50/50/Specify Product <br />Gal <br />Glycol Bulk Conc./Specify Product <br />- <br />Gal: <br />TEST: ❑ Clor D Tech 4000_ppm ❑ Clor D Tech 1000 ❑ Pass ❑ Fail ❑'Pass ❑ Fail <br />' <br />Retain sample &ITotal <br />Charges <br />Re uired <br />Field Service Work Description: <br />Other. <br />x* <br />N' U <br />Consolidated Manifest <br />� <br />CHECKLIST <br />Evergreen Oil, Inc. <br />6880 Smith Ave. <br />Evergreen Oil, Inc. - Davis Evergreen Oil, Inc. - Fmsn <br />❑Road 30B ❑ <br />(� '`DRIVER <br />Time tit_ rte. 4 Time Out <br />�, <br />Newark, CA 94560 <br />4139 N. Valentine <br />Davis, CA 95616 Fresno, CA 93722 <br />Tank/Drum Properly Labeled <br />CAD980887418 <br />CAD982446874 CAD982446882 <br />- Accumulation Start Date Marked <br />❑ Evergreen Env. Svc. <br />❑ Eraaeengl, Inc-SauaMaia❑ <br />House Keeping Clean <br />16604 S. San Pedro <br />Carson, CA 90746 <br />745 A West Betteravia <br />Santa Maria, CA 93454 <br />Other Services Checked: 0 Oil, 0 Filters/Drums, O Antifreeze <br />CAD981696420 <br />CAD982446858 <br />0 Called in other services needed 0 Oil, 0 Filters/ ins, 0 Antifre <br />Source: ❑ Collection StationGenerator <br />❑ Government <br />certifies that it has established a program to reduce the volume or <br />quantity & toxicity of the hazardous waste to the degree determined by <br />❑ Marine <br />❑ Agricultural ❑ Industrial <br />generator to be economically practicable. <br />I hereby certify that I have read and have the authority to <br />bind the above listed venerator 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, and financial assurances for <br />closure 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 />and not these�more stringent requirements. This notification is for information purposes only. <br />Driver Signature Print Name Route # Date Generators Signature Print Name Date <br />White Coov=Customer Coov - Pink & Yellow Coov=Office Use - Green Cnnv=Attach to manitest - r;Mrla Cnnv=nriapr Cnnv <br />