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1010812010 10:07 fAX) P.0221045 <br />10 WORK ORDOSERVICE AG RT <br />Evergreen Environmental Services <br />dedicated to The prorerrinn of the- eitvtrpnMettt N2 5017-90 <br />To schedule a pickup, call Send payment to: Salm Order #- <br />'800-596-9455 Evergreen Oil, Inc, <br />OM Smith Ave., Newark, CA EPAs CkDoe2413202 P.O. BOX 30517 <br />18540 S. San Pedro St, Caramn• CA EPA# CAD982413262 Los Angeles, CA 90030-0517 Date: i a' �� } <br />1. YIi�YY�rs ♦ IrtA�f .T�„- ' <br />!life <br />1 • <br />CITY STAT'.,* ZIP CO. CITY STATE ZIP <br />PRONE NO, PHONE NO. PROFILE NO. CUSTOMER EPA ID NO, <br />PRODUCT WASTE MANIFEST <br />CODE NUMBER QUANTITY UNITS PRiCE AMOUNT <br />UWd nil, Non•RCRA 1.10zar loUS Lubricating CA221 t a V , a',, i.` Gal. <br />Waste, Liquid Indusu°ial CA221 Gal. <br />ik 1' rmanlve Antifimem, hun,1 RA Ha�ur %w CA134 Gal. <br />R Wa1.W C�almduuade I.Irwla, NQ41.. NA F(eallFW2 Gal. <br />0R &, Water• Nan-RCRA tiV. WWW Waste Liquid CA221 Gal, <br />Wsstc Solids ardt Sludges Gal. <br />Wash Out Such <br />brained Used Oil Filter; Drum <br />Non-RCRA Hazardous Waste Solids (oily debris) CA223 Dntrn <br />Empty Drums, Drum <br />Tramxportution !leen• <br />Nan Haiaudoug Water Gal• <br />Clycol Bulk 50/50 Gail. <br />Glycol Bulk Conc, Goi• <br />TEST, ® Chir D Tceb 4000 ppm [l Cter A Tech 1®Op❑ Pass n Fall ® Hitlugarn Deteckw/Flam a Test ® puss ❑ Pali <br />l=(cld Service Work Description: <br />Total Charges <br />Other. <br />Other. <br />Vwuum Servicers Time <br />Out or Yard—On S)tc Of Site 01't Load Stan Oft Load End Return ro Yard <br />TSDF ❑ Consolidated Manifest <br />livergreen 011, Inc. ® Evergreen Env, Svc, £vcryteon Env. Svc. ® AJS Filter !—'I <br />6850 Smith Ave. Road 30B 4139 N. Valentine 15131 Clark Ave. t! <br />Nmvark• CA 94560 i u is. CA 95416 Fre:.nu, CA 93732 Indunry. CA 91745 <br />C'AD98=741 S CAD092444g74 CAD981;46882 CA 7431 <br />Q£vcr g'rte Bay. Svc. j"I liverg=n Env. Svc. j `� CER CFR _ flrerntrar Env. Svc, <br />ttSGD4 5, San Pedro t_._1I 745 A West Bctteravia u 9!44 E- Slauson Ave, tt�®JJ 33210 Western 1474 Tuyynn Circle <br />Carsoh. CA YU746 Sauna Maria. CA 93454 Lm Analft, CA 9t8,t1 I Uniun City, CA t9587 Volley S riaya CA 95352 <br />CAD9816%420 C'AD982440859 CAf-(1( 10021 CALM0001507 CAL0=214411 <br />Source: ❑ 0011@CttOri Station ❑ GovernmentCletlelmor Certifies that it has es ablie.hed a pm(anean to reduce thr> volunn ex <br />quamily & toxicity of the hutaardum waste in the tictim determined by <br />❑ Marine ❑ A •Culture! e❑ Industria] generakar to be e:Cnnomicully pructicabie. <br />I hereb <br />certify that I have road and have the authority to <br />bind the above 'listed eterator to the terms un the reverse <br />Retain sample # 5 or this [arm. <br />IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br />Per California Health and Safety Code Section 251-40.9, Evergreen hereby advixe:! custorll9F-chat customer's shipment oi' used tail may he <br />transported to at fucility that is ri:41ruxl to comply with federal regulations applicutlle to manuosnrml of w4cd oil, but that is not requu'ea to <br />comply with tate more stringent reyuirotnwit,; applicable to hazardous waste management facilities. Cuilfornia facilities that handle or process used <br />oil un m*uirvd to nicut those more suinoent requirement%. and xonw out -of -stater facilities that process muuii ul,,.0 meet tho%e requirertienis. <br />Th'"include more stringent leak detection and prevention requirements, engineering etertificutiont. or tank integrity, and financial assurance.—, for <br />closure Lind occidental releases. It is lawful to st:nd usod fail to out-ur.state facilitiea that Comply only with fedcsYtl used oil munugenvent standard <br />and not these entire stringent re'quiruments. This nntiticatipn is for intbrmafion putpoat:t linly. <br />