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I VREGalwa ICE AGREEMENT Evergreen EnviroAlental Services D 2 2p14 N° 693145 dedicated to the protection(?f the envirnnntent i ,N To schedule a pickup, call Send payment to: es Order# 800-972-5284 Evergreen Oil,kNVIRONMENTAta'LTH 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 16540 S.San Pedro St.,Carson,CA EPA//CAD982413262 Pasadena,CA 91185-3234 Dater—Z GENERATOR/JOB LOCATION BILLING INFORMATION N ME NAME CASH❑CHECK❑ # DRESS _ ADDRESS C OTE R CCODE NO. 2.�p(oS7 �OG � V CI Y STATE ZIP CO. CITY STATE ZIP CO. PO# 4 Ur PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA 1D NO. PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT CODE NUMBER Used oil,Non-RCRA Hazardous Lubricating CA22 't,4j't.A(,6 J Gal. Waste,Liquid Industrial CA221 Gal. Used Automotive Antifreeze,Non-RCRA Hazardous CA 134 Gal. Wave Liquid RQ Waste Combustible Liquid,N.O.S.NA FICA 221 Gal. 1993 111(Oil contaminated with halogens) 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 P'ns, y Transportation . Fuel Surcharge Glycol Bulk 50/ Specify Product • Glycol Bulk nc./Specify Product Gal. TEST:ZClor D Tech 4000,za—ppm ❑Clor D Tech 1000 Pass ❑Fail Retain sample# Total Charges Required 7 G q - Field Service Work Description: Other: Other: TSD Consolidated Manifest DRIVER CHECKLIS Ever reen Oil,Inc. Evergreen Oil,Inc.-Davis Evergreen Oil,Inc.-Fresno ❑ Time Ir Time Out 6880 Smith Ave. ❑ Road 30B ❑ 4139 N.Valentine ❑ Tank/Drum Properly Labeled Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 CAD980887418 CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked ❑ Evergreen Env.Svc. [:] EvagimOalnc.-SataMimF-1 ❑ House Keeping-Tank/Drum Clean 16604 S.San Pedro 745 A West Betteravia L 1 ❑ Other Services Checked: ❑Oil, ❑ Filters/Drums, ❑Antifreeze Carson,CA 90746 Santa Maria,CA 93454 ❑ Called in other services needed ❑Oil, ❑ Filters/Drums,❑Antifreeze CAD9816964_36 CAD982446858 Generator certifies that it has established a program to reduce the volume or Source: 2rCollection 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 Losur nd accidental releases.It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards these d more stringent requirements.This notification is for information purposes only. V� river Signature not Name Route# Date r Generat r s Signature Pri ante Date