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10/0812010 10:06 fAK} P.0201045 0 WORK ORDAERVICE AGREEMENT Am go Evergreen Environmental Services O 521546 ZOOM dedicated to the protection of the environment To schedule a pickup, call Send payment to; Sales Order # 1000XURI 1 800-596-9455 Evergreen oil, Inc. 8380 Smith Ave., Newark, CA EPA# CAt)e82413262 P.O. BOX 30517 166 S. son Pedro St., Carson, CA EPA# CADgB241sm Los Angeles, CA 90030-0517 Date: ? GENERATOR/ 0111 LOCATION BILLING MWORMATION N NAME CASH ® CHECK ❑ its Used oil, Won-RCRA Hazardous Lubricating ADDRESSADDRESS °Z T_a-A,00 t on CODE NO. ELtb 1PO@ 0 -Ty STA,'13 ZIP CO. CITY STATE ZIP CO. PHONE NO. PHONE NO. PROFME NO. CUSTOMER EPA ID NO. `l Gail Oil & Water, Non-RCRA Hazardous waste Liquid PRODUCT WASTE MANIFEST CODE NUbMER QUANTITY UNITS PRICE AMOUNT Used oil, Won-RCRA Hazardous Lubricating CA9.2-7 Gal. Waste, Liquid Industrial CAM Gail Umd wA oave Amif� owoo LkWW. Non-RCRA Howdam CAI34 �. Gal. t4 uaue Cem�s&b!o L iQuid, N.D S. NA R�i� Gail Oil & Water, Non-RCRA Hazardous waste Liquid CA221 fiat. ~� Waste Solids and Sludges Gal. Wash Out Bash Drained Used Oil Filters Drum Non-RCRA hazardous Waste Solids (oily debris) CA223 Drum )�tnpty Drums Drum Transportation Hrs. Non Hazardous Water Glycol Bulk 50/50 Glycol Bulk Conc. tial. TOT. ❑ Cior D Ted) 400o-4pm ❑ Clor D Trach 1 am [3 Pass ® Fait 1. Ogen Detector/Flame Test ass ❑ Fail Field Service Work Description: Total Chat e5 Other: other Vacuum Services Tlme Out, of Yard— On Site Off Site Off Load Start r... _ ff Load land Return to Yazd TSDF Consolidated Manifest 8vergreen 011, lac. vergreett Env. Sva 13v reen Env. Svc, AJS Filter 6880 Smith Ave. Road 30B ❑ 4139 N. Valentfue ❑ 15131 Clerk Ave. ❑ Kcwa*, CA 94560 Davis, CA 95616 Fresno, CA 93722 Industtryry,� CA 91745 CAD980997418 CAD982446874 CAD982446882 CAI1<f00097432 Evcrgreon Euv. Svc. Svcr�eoft l?nv. Svc. CFR r7 CFR ❑ Grtetimf Env. Svc. Ibb04 S. San Pedro, ❑ 745 A West Beitetavia ❑ 944 E. Slauson Ave, lint 332[0 Weslrn 3474 Toyyon Circle Carson, CA 90746 Santa Mala. CA 93454 I.os AngeIes, CA 9001 I Union City, CA 94557 Vulteyy 5prings, CA 9$352 CAD931690420 CAD982446858 CAL 110021 CAL000091507 CAL{10021Z"I SOUICe' ❑ CO11eCttOri Station ❑ Ca®VCrflffi811t ocnemor certifies that it has astablished A program to reduce the volume or • quantity & toxicity of the hazardous waste to the degree determined by ® Marine ❑ Agricultural ❑ Indastrial generator to be economically practicable. I hereby certify that I have read and have the authority to bind the above listed taenerator to the terms on the reverse Retain sample # side of this�fomL IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. Per California Health and Safety Code Section 25250.9, Evergreen hereby advises customer that customer's Shipment of used oil may be transported to a facility that is required to comply with federal regulations applicable to management of used oil, but that is not required to comply with the more stringent requirements applicable to hazardous waste management facilities. California facilities that handle or process used oil arc required to meet those more stringent requirements, and some out-of-state facilities that procoss used oil also meet those requirements. These include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for closure and accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards and not, these more stringent requirements. This notification is for information purposes only. �►C �a�L ^2 �9 Z �IZA9 meq' ver Sionntt Y1N PtSnt NA1RniitP 9 T)nrw '(ernPrntnec gionanirw Print Nnt»p ITSoto