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+y to ot�l muulu a plump, "au OUIM F"JI11c11L w. <br /> Sales Order# <br /> 800-596-94F`­ <br /> Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD98241.,__t Dept.LA 23234 ., ? <br /> 16540 S.San Pedro St.,Carson,'CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: _;_7Z c•� <br /> Lf <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NAME NAME CASH Q CHECK <br /> # <br /> ADDRESS ! ADDRESS CUSTOMER CODE NO. <br /> Y STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> CA <br /> ONE NO. PHONE NO. PROFILE NO. CUSSOMER EPA ID NO.fJ f <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA2 1 Gal.. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Automotive Antifrem.Non-RCRA Hazardous CAI 34 Gal. <br /> Waste Liquid <br /> RQ Waste Combustible Liquid.N.O.S.NA CA221 Gal. `i <br /> 1993 W(Oil contaminated with halo ens) FWIIFO02 <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 1 <br /> Transportation Hrs. <br /> Fuel Surcharge % <br /> Glycol Bulk 50/5 pecify Product Gal. <br /> Glycol Bulk n JSpecify Product Gal. <br /> TEST: Clor D Tech 4001)�ppm ❑Clor D Tech 1000 orp. Fail <br /> Retain sample#++ Total Charges <br /> Required t Z c, <br /> Field Service Work Description: <br /> Other- <br /> Other: <br /> therOther: <br /> TSD Consolidated Manifest DRIVER CHECKLIST <br /> vergreen Oil,Inc. ❑ Evergreen Oil,Inc.-Davis a Evergreen Oil,Inc.-Fresno ❑ Time In Time Out <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 ❑ Tank/Drum Properly Labeled <br /> CAD980887418 CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked <br /> Evergreen Env.Svc. ❑ EvaL=n0il lrc.-Sa=Maifl[] ❑ House Keeping-Tank/Drum Clean <br /> 16604 S.San Ped 745 A West Betteravia ❑ Other Services Checked: ❑Oil, ❑ Filters/Drums, ❑Antifreeze <br /> Carson,CA 907 Santa Maria,CA 93454 <br /> CAD98169 CAD982446858 10 Called in other services needed Oil, ❑ Filters/Drums,❑Antifreeze <br /> Source: Collection Station ❑Government Generator certifies that it has established a program to reduce the volume or <br /> 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 /> 71 include more stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> clos r and accidental releases.It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> anc more stringent requirements.This notification is for information purpos nly. <br /> —� -1-1 _JL � 2--71,-f-t 7- 1 river Signature Trint Name Route# DateGenera r s 1� lure Print Name Date <br /> v White Copy=Customer Copy-Pink&Yellow Copy=Office Use-Green Cod= [tach to anifest Golden Copy--Driver Copy <br />