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10/08/2010 10:05 fa P.0181045 <br />WORK ORDIOSERVICE AGREEMENT <br />Evergreen Environmental Services N2510675 <br />dedicated to the protection of the enviromant <br />To schedule a pickup, call Send payment to: <br />C G Sales Order # <br />800-596-9455 Evergreen Oil, Inc. <br />Saw Smith Ave,, Newark, CA EFA# CAD98241WM P.O. BOX 30517 <br />18540 S. San Pedro St., COMM CA EPA# OAD982413262 Los Angeles, CA 90030-0517 Date: • o <br />C�1:7Ti7i"Ali liil t ll 1151 t t t>, Z�t e s tz = e <br />PRODUCT <br />WASTE <br />CODE <br />HA.NEFE,ST QUANTITY UMTS PRICE AMOUNT <br />NUMBER <br />% _W%,i(� <br />r�^ a <br />CA2214 <br />Gal. <br />Waste, Liquid Industrial <br />CA221 <br />cal. <br />Veld Avwmrnive Aptam,,, Non-ACRA Heemian <br />Wum Liquid <br />CA l34 <br />Gal. <br />�.� i <br />W <br />(32.1.t <br />Oil & Water, Non -RCM Hazardous Waste Liquid <br />CA221 <br />Gal. <br />�.: T I Ll <br />Gal. <br />PRODUCT <br />WASTE <br />CODE <br />HA.NEFE,ST QUANTITY UMTS PRICE AMOUNT <br />NUMBER <br />Used oil, Non --CRA Hazardous Lubricating <br />M <br />CA2214 <br />Gal. <br />Waste, Liquid Industrial <br />CA221 <br />cal. <br />Veld Avwmrnive Aptam,,, Non-ACRA Heemian <br />Wum Liquid <br />CA l34 <br />Gal. <br />aQ verde CL911umbusdMe t,*K NA & NA <br />(32.1.t <br />Oil & Water, Non -RCM Hazardous Waste Liquid <br />CA221 <br />Gal. <br />Waste Solids sad Slud4os <br />Gal. <br />Wash Out <br />Each <br />Dralaed Used Oil Filters <br />Dkum <br />Moa-RCRA Harimk s Wane SO4de (oily debris) <br />CA223 <br />Drum <br />Empty Drtttns <br />Dntm <br />Transportation <br />Hrs. <br />Mon hazardous ®r <br />Oal. <br />Glycol Bulk 150150 <br />Gal. <br />Glycol Bu Conu. <br />TEST: Vaor D Tech ppm ❑ Clor D Toth 100D <br />Pols ❑ Fail ❑ Halogen DuactnrMamo Tit ❑ Fail <br />Pield Service Work Description: <br />Total Charges <br />Other. <br />Other <br />Vacuum Se Time <br />Out of Y On Slie Off Site <br />Off Load Start Off Load End —R- am to Yard <br />TS •6 consolidated Manifest <br />Evergreen Oil, Inc. Evergt�en Rnv. Svc. ® Evergreen Env. Svc. ® AJS Filter ❑ <br />6880 Smith Ave. Road 30B 4139 N. Valentine 15131 Clark Ave. <br />Newark, CA 94560 Davis, CA 95616 Fresno, CA 93722 Industryy, CA 91745 <br />CAD980887418 CAD982446874 CAD992446882 CAD000097432 <br />ElEver$recn Env, Svc ® Evergreen Env. Svc. ❑ CPR 1-1 CFR � Greenleaf Env. Svc. <br />!6604 S. San P 745 A West Bsttet'avia 1J 944 E. Slauson Ave. t�.-..J 33210 Western 3474 Toyyon Circle <br />Carson, CA 907J6 Santa Maria CA 93454 Los Angeles, CA 90011 Union Ciry. CA 94587 Vali S��rriin�ggss,, CA 95352 <br />CAD9816964 CAD98244�85tl CAI.000110021 CAL00M915071 CAL000214411 <br />SouTCt:: C`011eCtiOn $tatiori U Government Gene certifies that it has establishod a program to reduce the volume or <br />quantity & torJelty of the hazardous waste to the degree determined by <br />❑ Marine ❑ Agricultural ❑ Industrial genennor to be ceonomically 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 />Retain sample 0'00 <br />side of this fonts, <br />MTORTANT NOTICE REGARDING THE DISPOSI;'I'ION 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 raeility 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 arc rc uired to meet those more stringent requirements, and some out -of --stare facilities that process used oil ulso meet those requirements. <br />The include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for <br />ci 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 />an It . these more stringent requirements. This notification is for information purposes only. <br />Difiver Signature Print Name Rrinte. # I)ritr rlayp.r. r'c kiansmirp. Print hlnmFp. lint <br />