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ve en Environmental iron ..ental Ser " � <br /> Evergreen <br /> N 4 ' <br /> 1.9. 0 dedicated tothe pon of the environment <br /> i 17 r` <br /> Tasnneh®dulE3 a pickup,calf Send payment to: Sales Order <br /> 80 <br /> 0-596-9455 iwve'rgreen Gil;lnc:: <br /> 6880 Sinith Ave.,Newark.CA EPA#CAD982413262 Dept:LA 2323 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Pasadena,CA 91185-3234 Date: t/l <br /> G NERATOR%JOB LOCATION BILLING INFORMATION <br /> ME <br /> NAME <br /> eS CASH®CHECK p <br /> # <br /> ADDRESS ADDRESS C E CODE NO: <br /> ST Ezip . CO. CITY STATE ZIP CO. P <br /> HONE NO` PHONE NO. PROFILE NO. CUSTOMER EPA <br /> ' <br /> PRODUCT WASTF MANIFEST QUANTITY UNITS = PRICE '—AMOUNT. <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA GAL <br /> Waste,Liquid Industrial CA22I Gal. <br /> Used Au of odv*A�1if�enm.No.4tCaA Naxa�dou: � ( A 134 ' <br /> _WeatnG' Lal: <br /> RQ 1Vaua Cbni sUteb t.IgietQ N. S.NA -CA221 <br /> 1 3 I bit cont Wa pato F001fiW2 Gat. <br /> Oil&Water,Non-RCR'A Hazardous Waste Liquid CA223 ; <br /> Non Hazardous Water Gal: <br /> Waste Solids and Sludges (}�; <br /> Wash Out . Each <br /> Pressure Washer/Steam Cleaner <br /> Day: .. r Transportation-Hrs. x` <br /> Fuel Surch " - <br /> Glycol Bulk 5 50/Specify Product Gal. <br /> Glycol Bu- , onc./Specify Product_�_ Gal. <br /> TEST: .Clor D Tech 4U(1 ppm ®Clot D Tech lo0o Pass®Fail Q Pass Q Fail <br /> Retain sample# TOtal Char es <br /> Required- <br /> Field Service Work Description: <br /> Other. <br /> Other: <br /> mac. _ •. <br /> M80PS, <br /> Consolidated Manifest VER CHECKLIST <br /> men Oil,Inc.. E l Eve t Oil,Inc.-Davisa Evergreen Oil,Inc.-Fresno ❑Time In ut <br /> ith Ave,' tJ Road 30B 4I39.N.Valentine <br /> Newark,CA'94$60 Davis,CA 95616 ::Fresno,CA 93722 ®Tattk/Drum Property Labeled <br /> CAD980887418 CAD982446874 CAD982446882 ! Accumulation Start Date Marked <br /> Evergreen'Briv.Sv ® .1 S IN�sra® ❑ House Keeping-Tank/Drum CIean <br /> 16604S San P. 745 A WesE Betteravia 13 Other-Services Checked:0 Oil, ❑ Filters/Drums, ❑Antifreeze.' <br /> :'Carson,CA 9 . 6 Santa Maria,CA 93454 ❑ Called in other servibes needed Oil, Filters/Drums, •Antifreeze <br /> CAD98169 0 CAD982446858 <br /> Generator certifies that it has established a program to reduce the volume;nr <br /> Source: 4 Collection Station ❑Government quantity&toxicity of the•hazardous wastvto the degree determined by <br /> .Marine riCultural eneratortobe.economicall. <br /> ❑ � ❑ Industrial g y.practicabie. <br /> Ij <br /> Agriby certify_thittjlliiYC reA[i And have to g.ifherity to . <br /> :hind!the abQy Yem <br /> Wde 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 aresequired to meet-those more stringent requirement;t;=and some out-of:state facilities that process used oil also meet those requirements. <br /> `These:i dude more stringent.leak detection and prevention requirements;•engineertng certifications.of tank integrity,and-financiat:assurances.for <br /> -,closit' nd accidental releases.It is lawful to send used oil to out=of-state•f4cilities that comply only withfederal used oil management standards <br /> and no:hese more stringent requ` eats:This notification is for informattf purposes <br /> 1404 x f <br /> Dri er Signature PrEt Name RdW # Date n tato s grrature Pr' ame D e <br /> White Copy--Customer Copy-Pink&YeIIQ-W CopytxOffice'Use}(been CdDv=Attach to manifest-golden Cnnv=nrlvar ron,r <br />