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10108/2010 10:04 FAX) P.0151045 <br />WORK ORD&SERVICE AGREEMENT <br />Evergreen Environmental Services, N2481.983 <br />dedic4atcd to the prorecrion of rhe enyironinent <br />"�.p To schedule a pickup, call Send payment to: <br />Sales Order # <br />800-596-9455 Evergrcasn oil, Inc. <br />SWO Smith Ave,, Newark, CA EPA# CAD9e24'132e2 P.O. BOX 30517 <br />16540 S. Sen Pedro St., Carson, CA EPAtt CAD982413a62 Los Angeles, CA 90030-0517 Date: ae <br />GENERATOR/JOB LOCATION BILLING INFORNIATTnN <br />PRODUCT <br />NAME <br />CASH ❑ CHECK ❑ <br />ADDRESS <br />ADDRESS <br />DE NO. <br />PO 0 <br />CITY S TE P CO. <br />CITY STATE ZIP CO. <br />LPHONE, NO. <br />v <br />PHONE NO. <br />P120FILE NO. <br />I <br />CUST MER fll>A ID Is <br />I ''' - N <br />PRODUCT <br />WASTE <br />CODE <br />MANIFEST QUANTITY UNITS PRICE AMOUNT <br />NUMBER <br />Used oil, Non-RCRA Hazardous Lubricating <br />Waste, Liquid _ Industrial <br />C <br />CA221 <br />Gal. <br />Gal. <br />vada Axtum&q Andffi Noa-RCRA Nanrdwz <br />Llautd <br />�. 1 <br />Gal. <br />R9D3)[[T�(4tr antComtrustlhle Liquid, N.O.I. NA <br />[ Otl1111944dt1v�+halxsns) <br />CA211 <br />filOrlFoo2 <br />Gal. <br />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />CA22I <br />Gal. <br />Waste Solids and Sludges <br />Gal. <br />Wash out <br />Each <br />Drained Used Oil Filters <br />Drum <br />Non•RCRA Hazardous Waste Solids (oily debris) <br />CA223 <br />Drum <br />Empty Drums <br />Drum <br />Transportation <br />Hrs. <br />Non Hazardous W <br />Gal, <br />Glycol Bulk Z51Y50 <br />Gal, <br />Glycol Bul Cone. <br />Gal. <br />TEST: Rrmr D Tech 400 pm D C1or D ` mh io00 <br />Pass ❑ Pail ❑ Halogen DetactorMame Test Pass Q, Pail <br />Field Service Work Description: <br />Total Charges <br />Other; <br />Other: <br />Vacuum Se Tkne <br />put of Y -_ On Site Oft Site <br />0 -or OPOOF <br />Off Load Stat1 le Off Load Sari eturn to Yard <br />T <br />Evergreen Oil, Inc. <br />6880 Smith Ave. <br />Newark, CA 94560 <br />CAD980887418 <br />Consolidated Manilfesl <br />Bve rcxn Env. Svc, D Evergreen Env. Svc. ❑ AaS Filter <br />Road 30B 4139 N, Valentina 15131 Clark Ave. <br />Davis, CA 95616 Fresno, CA 93722 Industry, CA 91745 <br />CAD982446874 CAD982446382 CA000097432 <br />r <br />Evergreen Env, Svo Evergreen Env. Svc. ❑ CFR ❑ CFR ❑ Greenleaf Env. Svc. <br />16604 S. San Ped 745 A West SetterAvin 944 E. Sgglauson Ave. 33210 \vrcyystem 3474 Toyon Springs, <br />Carson CAta, 961CA 07 CAD9Santa &2446t;.59 ria, CA 93454 Lvi CAL00011�21A 90011 CALt00009i 94587 ValCAlI.W021441 CA 95352 <br />Generntor cees thut it hes established a program to reduce the volume or <br />[�70 <br />urce: UfCollection Station ❑ Government quantity & toxicity of the hazardous waste to the degree dettvinined by <br />❑ Marine ❑ Agricultural ❑ Industrial generator to be economically pnctienble. <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 />Retain sample 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 wide federal regulations applicable to tnanagentent 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 />Oi <br />lrequired to meet those more stringent requirements, and some out -of -stale facilities that process used oil also meet those requirements. <br />more ore sttin ent leak detection And prevention requirements, engineering certifications of tank integrity, and financiul ussurances for <br />ce and accidental releases_ It is lawful to send used oil to nut -of -state facilities that comply only with federal used oil management standards <br />a these more stringent requirernents. This notification is for information purposes <br />vP.r <br />ow <br />IL 1V'V Jj <br />Cionnrnri- <br />Print tgnnla Pr,uta .4 Ante/: <br />,e..,t..,•�. , .,,r n,,e` D : ,a 4... <br />n., <br />