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W �� CE AGREEMENT <br /> Evergreen Envialmental Services No 692995 <br /> dedicated to the protection of the environment <br /> To schedule a pickup,call Send payment to: SAN 0 2 2014 <br /> Sales Order# <br /> 800-972-5284 Evergreen Oil,In4ENVIRONMENTAL <br /> 6880 Smith Ave.,Newark,CA EPA#CAD9824132(2 Dept.LA 2323 H�pLTH DEPARTME <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-32Y I Date: 'U It" 1 <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> AM NAME CASH❑CHECK❑ <br /> # <br /> DD SS ADDRESS CUSTQMER CODE NO. <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> PHONE NO. , PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA22 qGal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Automotive Antifreeze,Non-RCRA Hazardous CA 134 Gal. <br /> Waste Liquid <br /> RQ Waste Combustible Liquid,N.O.S.NA CA221 Gal. <br /> 1993 In(Oil contaminated with halogens) F001/F002 <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA223 Gal. <br /> Non Hazardous Water Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Pressure Washer/Steam Cleaner Day <br /> Transportation Hrs. <br /> Fuel Surcharge % <br /> Glycol Bulk 50/5 pecify Product Gal. <br /> Glycol Bulk 04c./Specify Product Gal. <br /> TEST:2fclor D Tech 4000—Ut-ppm ❑Clor D Tech 1000 Pass ❑Fail <br /> Retain sample#/ Total Charges <br /> Required (a> <br /> Field Service Work Description: <br /> Other: <br /> Other: <br /> TS F Consolidated Manifest DRIVER ] L T <br /> Evergreen Oil,Inc. ❑ Evergreen Oil,Inc.-Davis[:] Evergreen Oil,Inc.-Fresno ❑ Time In Time Out <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine ❑ Tank/Drum Properly Labeled <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 <br /> CAD980887418 CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked <br /> ❑ Evergreen Env.Svc. ❑ EwUealMhr--Sat1laMMara❑ ❑ House Keeping-Tank/Drum Clean <br /> 16604 S.San Pedro 745 A West Betteravia ❑ Other Services Checked: ❑Oil, ❑ Filters/Drums, ❑Antifreeze <br /> Carson,CA 90 46 Santa Maria,CA 93454 <br /> CAD98169 ..0 CAD982446858 10, Called in other services needed Oil, ❑ Filters/Drums, Antifreeze <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> 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,and financial assurances for <br /> closur d 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 n t ese more stringent requirements.This notification is for information purposes only. <br /> ver Signature Print Name Route# Date Generator s Signature Print Name Date <br />