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WORK ORD SERVICE AGREEMENT
<br /> Evergreen Enviranental Services N-0 555156
<br /> dedicated to the protection of the environment
<br /> To schedule 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 —`J
<br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date:
<br /> GENERATOR/JOB LOCATION BILLING INFORMATION
<br /> NAME NAME
<br /> .ry CASH Q CHECK E]
<br /> /rte► .� #
<br /> ADDRESS ADDRESS CUSTOMER CODE NO.
<br /> CI STATE ZIP CO( CITY STATE ZIP CO. PO#
<br /> PHON O. PHONE NO. PROFILE NO. CUSTOMER EPA D N0.
<br /> e2 , PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT
<br /> CODE NUMBER
<br /> Used oil,Non-RCRA Hazardous Lubricating CA2 Gal.
<br /> Waste,Liquid Industrial CA221 Gal.
<br /> Used Automotive Antifreeze,Non-RCRA Ha-Mous CA134
<br /> Waste Liquid Gal.
<br /> RQ Waste Combustible Liquid,N.O.S.NA CA221
<br /> 1993 In Oil contaminated with halogens) F001/F002 Gal.
<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
<br /> Transportation His,
<br /> Fuel Surcharge %
<br /> Glycol Bulk 5 50/Specify Product Gal.
<br /> Glycol BU/Conc./Specify Product Gal,
<br /> TEST: Clor D Tech 400 ppm Clor D Tech 1000 Pass Fail
<br /> Retain sample# Total Charges
<br /> Re uired li�)
<br /> Field Service Work Description:
<br /> Other:
<br /> Other:
<br /> ;'E
<br /> Consolidated Manifest DRI CHECKLIST
<br /> vergreen Oil,Inc. ❑ Evergreen Oil,Inc.-Davis❑ Evergreen Oil,Inc.-Fresno ❑ Time Ir 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.SvcEvagraenMIm-SardaMaoa� [I House Keeping-Tank/Drum Clean
<br /> 16604 S.San Pedro. 745 A West Betteravia ❑ Other Services Checked: ❑Oil, ❑ Filters/Drums, ❑Antifreeze
<br /> Carson, Santa Maria 93454
<br /> CAD9816964 ❑ Called in other services needed E]Oil, C] Filters/Drums,E]Antifreeze
<br /> 69CAD982446858 58
<br /> Generator certifies that it has established a program to reduce the volume or
<br /> Source: Collection Station ❑Government 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 /> Thes 'nclude 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 corn only with federal use it management standards
<br /> and these more stringent quirements.This notification is for information purposes on
<br /> Dr ver Signature Pnnt Name Route# Date I Generator's Signature Print Name Date
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