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KROM <MON)•JUL 8 2072 16:36/ST. 76:32/No. 7518684701 P 8 <br /> WORK QRDE -ERVICE AGREEMENT <br /> Evergreen Enviamental Services <br /> dedicated to the protection of the environment N_o 555156 <br /> To schedule a pickup, call Send payment to: <br /> Sales Order41 � <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#CA13982413262 Pasadena,CA 91185-3234 Date: <br /> GENERATORIJOB LOCATION BILLING INFORMATION <br /> gADDRESS <br /> - Twl NAME CASH Q CHECK <br /> ! t✓� <br /> ADDRESS CUS 2OffiR CODE NO. <br /> 0(6 <br /> ST`AT�E ZIP C CITY STATE ZIP CO. PO '�vetO. 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 G.J. <br /> lJscl Aulnmocm Antifreeze,Non-RCRA nawduus <br /> weseu n� CA134 Gal. <br /> RQ wane Cotntwstibl1 Liquid, 11-1 NA CA22I <br /> 1993 m Oil mnmtninatcd with hW rnx FWIIFW2 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 oc Hrs. <br /> Fuel Surcharge % <br /> Glvcol Bulk 5 501Specify Product Gal. <br /> Glycol Bu Conc.ISpecify Prrodu`ct Gal- <br /> TEST-[ <br /> alTEST: . Clor D Tech 40(�-� ppm Oor D Tech 1000 Pass El Fail <br /> Retain sample# Total Charges <br /> Required_ <br /> Field Service Work Description: <br /> Other. <br /> Other: <br /> TS Consolidated Manifest DRIV CHECKLIST <br /> Evergreen Oil,Inc. L1Fvefgrren Oil,hic.-Davis[:] Evergreen Oil,Inc.-Fresno E3Time hi—Time Out <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 0 Tank/Drum Properly Labeled <br /> C.AD980887418 CAD982446874 CAD982446882 ❑ Accumulation Start Date Marked <br /> ❑ Evergreen Env.Svc. EvegtearOl,fic,-S=Maia❑ ❑ House Keeping-Tank/Drum Clean <br /> 16604 S.San Pedro 745 A West Betteravia <br /> Carson,C ❑ Other Services Checked:EI Oil, ❑ Filters/Drums.❑Antifreeze <br /> A 907 Santa Maria,CA 93454 <br /> CAD9816964 C.AD982446858 10 Called in other services needed Oil, Filters/Drums,❑Antifreeze <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: t Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑Marine ❑ Agricultural ❑ Industria] generator to he economically practicable. <br /> I hereby certify that I have read and have thea to hority to <br /> bind the above listed generator to the terms on the revere <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 /> CIOs and accidental releases.It is lawful to send used oil to out-of-state facilities that Coin o ly with federal us it management standards <br /> anjDver <br /> these more stringent quirements.This notification is for information purposes on <br /> Signature not Name Route# Date I Generator's Signature Print Name Date <br /> Whifo(:nnv—(:,tcfnmor r:nrnt_�in4 R,volmrou <br />