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IK,WORORDER/SERVICE AGREEM�',NT
<br /> -4 Evergreen Environmental Services N° 636937
<br /> dedicated to the protection ojthe environment
<br /> To scheduls a pickup, call Send payment.to: Sales Order#
<br /> 800-596-9455 Evergreen Oil,Inc.
<br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234
<br /> 16W S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date:,C 1_4
<br /> GENERATOR/JOB LOCATION BILLING INFORIMATION
<br /> NAAIV NAME CASH❑CHECK
<br /> DRESS ADDRESS CUSTOMER CODE NO.
<br /> qc Gw c
<br /> STATE IP CO. CITY STATE ZIP CO. PO#
<br /> �.S Z..
<br /> ONE NO. —
<br /> t PHONE NO. PROFILE NO, CUS MEfR LP ID O.
<br /> 190 ( ALPRODUCT WASTE MANIk'EST
<br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT
<br /> Used oil,Non-RCRA Hazardous Latxicating CA2 1 Gal,
<br /> Waste,Liquid Industrial CA')')1 pal,
<br /> aware Liquid Used AUIdroiWAndhaea,Non-kCRAH4%Udoun l,.,A134 (jai.
<br /> 1
<br /> R WPtRo Gombn�Nhlc lJ9¢Id.n.p.A,NA I�A002 Gal.
<br /> ! 111 011 mn l wNi ha n�
<br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA223 pal,
<br /> Non Hazardous Water Gal,
<br /> Waste Solids and Sludges Gal. ULI 0 6 _
<br /> Wash Out Each
<br /> Pmsswc Washer/Steam Cleaner
<br /> Day
<br /> wc:Ai rlj CD6RTAAGAIT
<br /> TranaportiWon Firs,
<br /> Fuel Surcharge %
<br /> Glycol Bulk 501JApecify Product Gal.
<br /> Glycol Bulk tSpecify Product_... Gal.
<br /> TEST:RfCl,D Tech 400 rpm [f Clor D'Itch 1000 Pail
<br /> Retain sample# Total Charges
<br /> Required 11
<br /> Field Service Work Description:
<br /> Other:
<br /> Other:
<br /> �49slln
<br /> Consolidated Manifest DRIVER CHECKLIST
<br /> oil,Inc. Evergreen Oil,Inc.-Davis Evergreen Oil,Inc,-Fresno ❑ Time It+ TimeOutmith Ave. E] Road308 ❑4139 N.Valentine
<br /> Newark,CA 94560 Davis,CA 95616 Fresno CA 93722 ❑Tank/Drum Properly Labeled
<br /> CAD%0887416 CAD982446874 CAD96446892 ❑ Accumulation Start Date Marked
<br /> Evergrccn Env,Svc, Ew �t7il,lnc•Sanmtvlmia ❑ House Keeping-Tank/Drum Clean
<br /> 16604 S.San Ped ❑ 745-A West Bettetavia ❑ ❑Other Services Checked: ❑Oil, ❑ Filtcrs/Drums, ❑Antifreeze
<br /> Carson,CA 907A Santa Marla, 93454
<br /> CAD9B1696 CAD9$2446$58 ❑ Called in other services needed Oil, Filters/Drums, Antifreeze
<br /> 58
<br /> Gencrator certifies that it has established a program to reduce the volume or
<br /> Source: Z1 Collection Station Cl Government quantity&toxicity of the hazardous waste to the degree determined by
<br /> ❑Marine ❑ A 'cultural ❑ Industrial generator to be economically pn,eticable.
<br /> L.herebycertifiAbut I have toad and have the authority ln-
<br /> bind the above Listed Pen to fhn farms on the reyerse
<br /> Aide 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 /> Thes include more stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for
<br /> cloa 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 /> an n t those more stringent requirements,This notification is for information p4Gena
<br /> 7.
<br /> IN `2'
<br /> river Signature -Print Name Route# Date 4i2��ePrint Name bate
<br /> White Conv=Cuvtrunar t' Rink R vnllnu Mn,—rirfir t� n. n,.. .
<br /> ZZ01900'd '"' 6 - 8V:1r1 SIOZl90l01
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