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1010812010 10:03 TA)0 P.O 141045 <br />WORK O SERVICE AGREEMENT <br />./ Evergreen Environmental Services o Q 91624 <br />dedicared to the prOlOWOrt of /he dnvironnionj <br />To schedule a pickup, call Send payment to: Sales Order # <br />800596-9455 Evergreen 011, Inc, <br />9000 Smith Ave., Newark, CA EPA# CAD962413262 P.O. BOX 30517 ®� Y <br />16S4o s. Ban Pedro St., careen, CA EPA# CAD982413262 Los Angeles, CA 90030-0517 Date: <br />GENERATOR/JOB LOCATION BILLING INIT ORNIATION <br />CASH Lj CHECK u <br />CU O O E <br />STATE ZIP CO. PCY # <br />�jPROk' U NO. CUSTOMER EPA ID NO, <br />PRODUCT <br />WASTE <br />CODE <br />MANIFEST QUANTITY UNITS PRICE <br />NU7v1BER <br />ANIOUNT <br />Used oll, Non•RCRA Hazardous Lubricating <br />CA2 <br />a Gal. <br />Waste, Liquid Industrial <br />CA22I <br />Gal. <br />w nuwmidw PmUfmmM ffts-RCRA t+pVraoer <br />e <br />CA t3 <br />. Gat. <br />A 2to ConN+u zW* Ajd141 N=,A <br />CA221 <br />Gal <br />Oil & Water. Non•RCRA Hazardous Waste Liquid <br />CA221 <br />Gal. <br />Waste Solids and Sludges <br />Gal, <br />Wash OuL <br />Each <br />Drained Used Oil Film <br />Dmrd <br />Non-RCRA hazardous Waste Solids (oily debris) <br />- <br />CA223 <br />_ <br />Drum <br />Empty Drums <br />Drum <br />Transportation <br />Firs, <br />Non Hazardous ter <br />Gal. <br />Glycol Bulk 5060 <br />Gal. <br />Glycol Bu! Conc. <br />Gal, <br />immufCior, D Tech 40W2404pm ❑ Clor D Tech 1000 <br />[' !ass ❑ Fail ❑ Halogen Deteetor/Ratne Test ❑ Fail <br />Field service Work Description: <br />Total Charees <br />Other: <br />Other: <br />Vacuum ices Time <br />' <br />Out of and On site __._..,Off Site <br />OLP Load Start OtF Lad End Return Yard <br />TS Consolidated Manifest <br />livergreen Oil, Inc. evcr�r®err Env. Svc. Evergreen Env, Svc. AJS Filter <br />6880 Smith Ave. Rad 308 ❑ 4139 N. valentine ❑ 15131 Clark Ave. ❑ <br />Newark, CA 94560 Davis, CA 95616 Fresno, CA 93722Industrryy� CA 91745 <br />CAD990887413 / CAD982446874 CAD982446882 CAD00009I432 <br />❑Evergreen Env. c. ❑ EveWeen Env. Svc. ® CFR ❑ CPR ❑ Greenlear Env. Svc. <br />16604 S. Sen ro 745 A West Boucravia 944 E. 3lauson Ave, 33210 Western 3474 To on Circic <br />Carson, CA 9 46 Scuta Moria, CA 93454 Los rLggel��, CA 900! E Union City, CA 94987 Valleyy� Syppr!»ggss CA 9S33Z <br />CAD98t69 0 CAD982446858 CAL0001IWI CAL000091507 CAL000214411 <br />Generator certifies Vint It has established m program to reduce the volume or <br />SOurc_e_ Collection Station ❑ Government quantity & toxicity of the hazardous wrste to lite degree determined by <br />® Marine Q Agricultural ® Industrial generator to be economically practicable. <br />Retain sample # <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 stdripp it requirements, and some out-of-state facilities that process used oil also meet those requirements. <br />These include more stringent Icak dctectioti and prevention requirements, engineering cervi i a ions of to4egrity, and financial assurances for <br />closure and accidents[ releases. It is lawful to send used oil to Drat -of -state facilities that Only w f crul Vied oil management standards <br />an of these more stringent requirements. This notification is for information purposes <br />In ivnr Cirtnnwern <br />0,4M- AT.,,,,e D ­ d.. 4 T1%,6_ <br />