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RK ORDER/SERVICE AGREEMENT <br /> Evergreen v ental Services <br /> dedicated to the protection t <br /> To schedule a pickup, ca' ATTACHMENT5 Sales Order A t3r�-j 3 Z%J� <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: <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> AME NAME CASH Q CHECK <br /> S <br /> ADDRESS CUSTOMER CODE NO. <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> 3 <br /> PHONE NO. PHONE NO. PROFILE NO. I CUSTOMER EPA ID NO. <br /> aro® 3?t ( ) t�Z <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA2LkQ 150 5ww4r, l Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Automotive Antifreeze,Non-RCRA Hazardous CA 134 Gal. <br /> Waste Li uid <br /> RQ Waste Combustible Liquid,N.O.S.NA CA221 Gal <br /> 1993 In Oil contami=2 with halo ns F001/F002 <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 Hrs, <br /> Fuel Surcharge % <br /> Glycol Bulk 50/50/Specify Product Gal. <br /> Glycol Bu Conc./Specify Product Gal, <br /> TEST. Clor D Tech 400AA-0—ppm ❑Clor D Tech 1000 171Pass Ej Fail <br /> Retain sample## Total Char <br /> Required <br /> �,. <br /> Field Service Work Description: <br /> Other: <br /> Other: <br /> TS Consolidated Manifest CHECKLIST <br /> Evergreen Oil,Inc. ❑ Evergreen Oil Inc.-Davis f� Evergreen Oil,Inc.-Fresno ❑ Time In Time <br /> 6880 Smith Ave. Road 30B LJ 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. ❑ EveT=0tfir.-SanraMada� ❑ House Keeping-Tank/Drum Clean <br /> 16604 S.San Pedro 745 A West Betteravia ❑ Other Services Checked: ❑Oil, ❑ Filters/Drums, ❑Antifreeze <br /> Carson,CA 90746 Santa Maria,CA 93454 <br /> CAD9816964 CAD982446858 ❑ 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: 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 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 /> andr1t these more stringent requirements.This notification is for information purposes only. <br /> 1, Z - 2' �.-- <br /> D er Signature Print Name oute# Date Generator's Signature Print Name ate <br /> ' <br />