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WORK ORDE16ERVICE AGREEMENT Aj Evergreen Env i ental Services u 523050 dedicated to rile protection of the environment To schedule a pickup,call Send payment to: Sales Order# 800-596-9455 Evergreen Oil,Inc. 6880 Smith Ave..Newark,CA EPA#CAD982413262 P.O.BOX 30217 16540 S.San Pedro St.,Canon.CA EPA#CAD982413262 Los Angeles,CA 90030-0517 Date: GENERATOR/JOB LOCATION BILLING INFORMATION NAME NAME CASH❑CHECK❑ ADDRESS ADDRESS CUSTOMER CODE NO. CITY STATE ZIP CO. CITY STATE ZIP CO. PO# PHONENO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT CODE NUMBER Used oil,Non-RCRA Hazardous Lubricating CA221 Gal. Waste,Liquid Industrial CA221 Gal. UsvJ Aurunxx Anifmam.Nnn-RCRA ri=v s CA134 Gal. wasw I: J RQ Wu a CombaAhk Liquid,N.O.S.NA FICA2210, Gal. 19gJ In lOil ammminaled wish ha caJ Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. Waste Solids and Sludges Gal. Each Wash Out Drained Used Oil Filters Drum Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum DrumEmpty Drums Has. Transportation Gal. Non Hazardous Water Glycol Bulk 50150 Gal. Glycol Bulk Cone. Gal. TEST:❑ Clor D Tech 4000---Ppm ❑Clor D Tech 1000❑Pass❑Fail ❑ Halogen DetectorfFlame Test ❑Pass ❑Fail Total Charges Field Service Work Description: Other: Other. Vacuum Services Time Out of Yard On Site Off Site—Off Load Start Off Load End Return to Yard TSDF ❑ Consolidated Manifest Evergreen Oil.Inc. F-1 Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ AIS Filter ❑ 6880 Smith Ave. Road 30B 4139 N.Valentine 15131 Clark Ave. Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Industry,CA 91745 CAD980887418 CAD982446874 CAD982446882 CAD000097432 Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ CFR ❑ CFR ❑ Greenleaf Env.Svc. ❑ 16604 S.San Pedro 745 A West Bettemvia 944 E.Slauson Ave. 33210 Western 3474 Toyon Circle Canon,CA 90746 Sana Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs' Zi ngs CA 95352 CAD981696420 CAD982446858 CA[.OW 110021 CALGenerat00091507 or certifies that it has established a program to reduce the volume or Source: ❑ Collection Station ❑Government quantity&tonicity of the hazardous waste to the degree determined by Marin ❑ 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 Retain Sample# 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 and accidental releases.It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards and not these more stringent requirements.This notification is for information purposes only.