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JAP WORK ORDER /cERVICEAGREEMENT �j Evergreen Emir - .cental Services N-0559840 dedicated to the protection of the environment /� -��. To schedule a pickup, call Send payment to: Sales Order # 6� 2 800-596-9455 Evergreen oil, Inc. 6880 Snrith Ave., Newark, CA EPA# CAD982413262 Dept. LA 23234 16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Pasadena, CA 91185-3234 Date: 77+ G GENERATOR/JOB LOCATION BILLING INFORMATION AME, f1� NQq r NAME DRIVER CHECKLIST ;y vergreen Oil, Inc. E 1:1Evergreen Oil, Inc. - Davis ❑ #CASH ❑ CHECK DItESS 1`I c L lh5 1- ADDRESS 4139 N. Valentine Fresno, CA 93722 ❑ Tank/Drum ProperlyLabeled CAD980887418 C TOMER CODE NO. CIT � l -- coTAT 'TCY�y ^ ZIP CO. J CITY STATE ZIP CO. P # PHON cE O. — CCX6 PHONE NO. c 1 PROFILE NO. CUSTOMER EPA ID NO. PRODUCT WASTE CODE MANIFEST QUANTITY NUMBER UNITS PRICE AMOUNT Used oil, Non-RCRA Hazardous Lubricating CA221 Gal. Waste, Liquid Industrial CA221 Gal. UseAummoti1e AmiReam Non-RCRA Ha ,,Ia warm a ma CAI34 Gal. RQWesm C..WoibletJ,,i4N.0s NA 1993 ITT (Oil =wminnwa wiut halo ns) CA221 F001,TD02 Gal, Oil & Water, Non-RCRA Hazardous Waste Liquid CA223 JII l� Gal. Non Hazardous Water Gal, Waste Solids and Sludges Gal. Wash Out Each Pressure Washer/Steam Cleaner Day Transportation jos, W 7 Fuel Surcharge % Glycol Bulk 50/50/Specify Product Gal. Glycol Bulk Cone./Specify Product Gal, TEST: Q Clor D Tech 4000—ppm ❑ Clor D Tech 1000 EjPass E] Fail Retain sample # Required Total Charges Field Service Work Description: Other: Other: r Z ,. TSDF ❑ Consolidated Manifest DRIVER CHECKLIST ;y vergreen Oil, Inc. E 1:1Evergreen Oil, Inc. - Davis ❑ Evergreen Oil, Inc. - Fresno ❑ Time In rime Out 880 Smith Ave. Newark, CA 94560 Road 30B Davis, CA 95616 4139 N. Valentine Fresno, CA 93722 ❑ Tank/Drum ProperlyLabeled CAD980887418 CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked ❑Evergreen Env. Svc.1:1Eepm Oill c-SaNaMma❑ 16604 S. San Pedro 745 A West Betteravia Carson, CA 90746 Santa Maria, CA 93454 CADQRIAQAA9n r`AD099dd6R A ❑ House Keeping - Tank/Drum Clean ❑ Other Services Checked: ❑ Oil, O Filters/Drums, O Antifreeze SOUI'Ce: LJ Collection Station Generator certifies that it has established a program to reduce the volume or ❑ 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 Eenerator 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 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. 22� / Dn�r Signature Print Name Route # Date enerator' 'ignatur Print Name Date Whim-- oI-G v III .... .-,._,._sr:__ 1__ ----- ••___ e -- -` •- - -- --, - r—