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10/0812010 10:06 (FAX} P.0191045 <br />24 <br />WORK ORDi&ERVICE AGREEMENT <br />:0Evergreen Environmental Services N2510955 <br />0A dedicated to the protection of the environment <br />To schedule a pickup, call Send payment to, Sales Order #i` <br />800-596-9455 Everpt en oil, Inc. <br />6880 Smlth Ave., Newark, CA EPAs r; AD9t32419282 P.O. BOX 30517 41 <br />18540 S. San Pedro St., carsrnt, CA I=PA# GAcee2413262 Los Angeles, CA 90030-0517 Date: °" _ <br />GENERATOWJO.B LOCATION BILLING [FORMATION <br />1 14 <br />-WAM, <br />CODE <br />MANIMT QUANTITY UNITS PRICE AMOUNT <br />NUMBER <br />Used oil, Non-RCR.A Hazardous Lubricating <br />Waste, Ligaid Industrial <br />A <br />y i A <br />CITY STATE ZIP CO. <br />tp,a A,nv,«1v* Antleim,. Non-RCRA ttez nkm <br />wow u <br />.4 6 <br />. lob <br />PRODUCT <br />-WAM, <br />CODE <br />MANIMT QUANTITY UNITS PRICE AMOUNT <br />NUMBER <br />Used oil, Non-RCR.A Hazardous Lubricating <br />Waste, Ligaid Industrial <br />CA22JM <br />CA221 <br />Gal. <br />Gal. <br />tp,a A,nv,«1v* Antleim,. Non-RCRA ttez nkm <br />wow u <br />CAE 34 <br />Gal. <br />RQ WWa C01=tilEle,0* Na S. NA <br />n1`9% <br />Gal. <br />oil & Water, Non RCRA Hazardous Waste Liquid <br />CwA221 <br />Cal. <br />Waste Solids and Sludges <br />Gal. <br />Wash Out <br />Bach <br />Drained Used Oil Filters <br />Dram <br />Non-RCRA Hazardous Waste solids (oily debris) <br />CA223 <br />Drum <br />Empty Dmms <br />Drum <br />Trans odation <br />tats. <br />Non Hazardous W r <br />Glycol Bulk 50/50 <br />fiat. <br />Gal. <br />t:ll , B -i Cone. <br />Gal. <br />TEST: aar D Tech ppm ❑ Clot D Tech 1000 <br />Pass ❑ Fail ❑ Halogen Deteetor/Flam TextPsas ❑ Feil <br />Field Service Work Desmiption: <br />Total Charges <br />Other: <br />outer <br />Vacuumexvices Time <br />OOut o aril On SiteOff Site <br />Off load Start Off L oad End Return kygfd <br />T F <br />Evergreen Oil. Itue. <br />0880 Smith Avc, <br />Newark, CA 94560 <br />CAD980387418 <br />[/Consolidated Manifest <br />❑ <br />Wo, 303 <br />Env. Svc. ® Evergreen Env. Svc. ❑ AJS Filter <br />Road 30B 4139 N. Valentine 15131 Clark Avc, <br />Davis, CA 95616 Fresno, CA 93722 Industry CA 91745 <br />CAD982446874 CAD982446882 rennit 107eT2 <br />❑Bvorgreen Env, Sv Ever &tv. Svc. ❑ CPR <br />16604 S. San ❑ 745 A West Bestteravin 944 B. Slaaeson Ave. <br />Ctsasort, CA 90 6 Santa Maria, CA 93454 Los Angeles, CA 9001 1 <br />CAD98169 CAD982446858 CALOW 110021 <br />[i-ource-:- <br />Collection Station Q Government <br />❑ Marine ❑ A.griculturaI ❑ industrial <br />Retain sample # <br />n <br />CFR ❑ Greenleaf Env. Svc. <br />33210 Western 3474 Toyon Circle <br />Union City CA 94587 Valley springs, CA 95352 <br />C <br />CALOOD091507 AL0002 441 <br />Generator txrdfics that it has established a program to reduce the volume or <br />quantity & toxicity of due hazardous waste to the degree detemnined by <br />generator to be economically practicable. <br />I hereby cortin that I have read and have the authority to <br />bind the above listed venerator t0 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 />TE a include more stringent leaf: detection and prevention requirements, engineering certifications of Lank integrity, and financial assurances for <br />cl re 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 tot. these more stringent requirements. This notification is for inforniatipn purposes only. <br />-too®lam �>j ��/3-dq <br />Driver ure not !Marna Rnute # Dgfi-.. t r�tnr'c . tcnstntro Print %mi.. 11nrP <br />