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FROM (MON>OUL 9 2012 16:33/ST. 16:a2/14-. 7519694101 P 6 <br /> wuxx U"V-' -"SExv ICE AGREEMENT <br /> ,� Evergreen Envi�mental Services N° 636206 <br /> mi dedicated to the protection of the environment <br /> rTf To schedule aicku call " <br /> p p. Send payment to: Sales Order# <br /> 800-596-9455 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept.LA 23234 <br /> 16540 S.San Pedro St„Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date:_l tl <br /> GENERATORIJOB LOCATION BILLING INFORMATION <br /> gNA NA �f CASH Q CHECK <br /> # <br /> CUSTOMER DE NO. <br /> ST E ZIP CITY STATE ZIP CO. PO N <br /> O. PHONE NO. PROFILE NO. CUSTOMER EPA NO. <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Used oil,Non-RCRA Hazardous Lubricating CA2 Gal <br /> Waste,Liquid Industrial CA221 Gal, <br /> Used Awomodye Aatif m Non-RCRA Hvvdaus <br /> Wage t.;uid CA 134 Gal. <br /> RQ"I Caobusuble Liquid,N.O.S.NA ;CA I <br /> 1993 nl Oil coonmineted with <br /> 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 ZHrs. <br /> Fuel Surcharge yrs <br /> Glycol Bulk 50/ /Specify Product Gal <br /> Glycol Bulk onc./Specify Product Gat <br /> TEST:Xclor D Tech 40002i.—ppm L1 Clor D Tech 1000 Pass []Fail <br /> Retain sample# Total Charges— <br /> Required <br /> har esRe uired <br /> Field Service Work Description: <br /> Other: <br /> Other: <br /> TS Consolidated Manifest DRIVER CHE <br /> Evergreen Oil,Inc. ❑ Evergreen Oil,Inc:.-Davis❑ 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 p Accumulation Stan Date Marked <br /> ElEvergreen Env.Svc. ❑ Em:p=C,brc.-S&mMada� ❑House Keeping-Tank/Drum Clean <br /> 16604 5.San Ped' 745 A West Betteravia ❑Other Services Checked: ❑Oil, Q Filters/Drums, ❑Antifreeze <br /> Carson,CA 907 Santa Maria,CA 93454 <br /> C.4D9816964 CAD982446858 ❑Called in other services needed Oil, FiltersiDrums, Antifreeze <br /> Generator Qertifies that it has established a program to reduce the volume or <br /> Source: YCollection 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 acner@tor 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 ar uired to meet those more stringent requirements,and some out-of-state facilities that process used oil also meet those requirements- <br /> Thes i lude more stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> clo re d accidental releases.It is lawful to send used oil to out-of-state facilities that com ly only with federal used oil management standards <br /> an not ese more stringent requirements.This notification is for information purposes o y. <br /> w <br /> /� - tr <br /> D ver Signature Pr—int Name Route# Date Generator's Signature Print Name Date <br /> Whito l:nm—r:i ietnmor(.nrn/-Pink 9 Voll—m I`nrw—(1Hiro 1 Ico-(:coon r--A Minh fn—R—+ <br />