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W &K RRkICE AGREEMENT Evergreen Envir nental ServicesJN 02 N-0 69307 !dedicated to the protection of the enrirzmntent To schedule a pickup, call Send paymenNVIRONMENT &ales Order# 800-972-5284 Evergreen Oil,IncHEALTH DEPAPTM._.N 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 /. J, 16540S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: GENERATOR/JOB LOCATION BILLING INFORMATION ME NAME CASH❑CHECK❑ # —ADDRESS ADDRESS CUMCODENO. CITY S ATE ZIP CO. CITY STATE ZIP CO. PO# PHONE NO. PHONE NO. ROFILE NO. CUSTOMER EPA ID NO. P PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT CODE NUMBER Used oil,Non-RCRA Hazardous Lubricating CA22 ' _ZK Gal. Waste,Liquid Industrial CA221 Gal. Used Automotive Antifreeze.Non-RCRA Hazardous CA 134 Gal. Waste Liquid RQ Waste Comhuetihle Liquid.N.O.S.NA CA221 Gal. 1993 In IOil contaminated with halo,-ens) F(X)l/F(N)2 Oil&Water,Non-RCRA Hazardous Waste Liquid CA223 Gal. Non Hazardous Water Gal. Waste Solids and Sludges Gal. Wash Out Each Pressure Washer/Steam Cleaner Day Transportation Hrs. Fuel Surcharge % Glycol Bulk 50 0/Specify Product Gal Glycol Bulk onc./Specify Product Gal. TEST: Clor D Tech 40002C.0—ppm ❑Clor D Tech 1000 Pass ❑Fail Retain sample# Total Charge Required c Field Service Work Description: Other: Other: TS Consolidated Manifest DRIVER CHE Evergreen Oil,Inc. Evergreen Oil,Inc.-Davis Evergreen Oil,Inc.-Fresno ❑ Time In Time Out 6880 Smith Ave. [:] Road 30B [:] 4139 N.Valentine Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 ❑ Tank/Drum Properly Labeled CAD980887418 CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked ❑ Evergreen Env.Svc. ❑ Et 10i41ne-SantaMaria❑ ❑ House Keeping-Tank/Drum Clean 16604 S.San Pedro 745 A West Betteravia ❑ Other Services Checked: ❑Oil, ❑ Filters/Drums, ❑Antifreeze Carson,CA 907,46 Santa Maria,CA 93454 CAD98169 CAD982446858 ❑ Called in other services needed ❑Oil, ❑ Filters/Drums,E]Antifreeze Generator certifies that it has established a program to reduce the volume or Source: Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by ❑ Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. I hereby certify that I have read and have the authority to bind the above listed generator to the terms on the reverse side of this 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. These include more stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for closure d accidental releases.It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards and n ese more stringent requirements.This notification is for information purposes only. river Signature Print Name Route# Date f Generat ' Signature Print me Date 1Alhi4n f nn..—f`.,c4mm�r/'nnv_OinL D_V IL...,!`.,...._l1Ki...+1 L.. /_.....n/'`....,._A�a., �....+...�i....♦ /_..L1....r...., .......r,,..,,