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1010812010 10:09 TO P.0251045 <br />WORK ORD&ERVICE AGROMENT <br />Evergreen Environmental Services ® 5 616 <br />dedicated to the protection of the onvinwwns <br />wr To schedule a pickup, call Send payment to: Sales Order # <br />800-596-9455 Evergreen Oil„ Inc. <br />6880 Smidh Ave., Newark, CA EP" CAD 243262 Dept. LA 23234 <br />16540 S. sen Pedro St., Carson. CA EPA# CAD992413262 Pasadena, CA 91185-3234 Date: Gly' <br />GE ATOR/JOB LOCATTON BILLING WORMATION 41 <br />7A$- 1 <br />m <br />PRODUCT <br />WASTE MANIFEST <br />CODE MERR r QUANTITY <br />UNI'T'S <br />PRICE AMOUNT <br />Used oil, Non-RCRA Hazardous Lubricating <br />CA221 v T 5 <br />Gal. <br />_ <br />Waste„ Liquid Industrial <br />CAx21 <br />Gal. <br />useewueouwaivsAeluwallowAC:IAHesmdour <br />CA134 <br />Gal. <br />� <br />1993 Ht Olt h bi �. NA <br />Oil & Water, Non•RCRA Hazardous Waste Liquid <br />T <br />�C � <br />CA223 <br />Gal. <br />Gal. <br />Non Hazardous Water <br />_ <br />Gat. <br />Waste, Solids pad Sludges <br />p <br />Gal. <br />Wash Out .w <br />r. <br />Each <br />Pressuro Washer/Stearn Cleaner <br />Day, <br />Transportation. <br />His. <br />Fuel surcharge <br />% <br />Glycol hulk SO/50/Specify Product <br />GAT. <br />Glycol Bulk ConcJSpecify Product <br />Gal. <br />TEST`. ❑ Clor D Tech 4000—ppm ❑ Clor D Tech 1000 ® Pass ® Pati ❑ Pass Feil <br />Retain sample # <br />Required <br />Feld Service Work Description: <br />Other: <br />Other. - <br />Total Charcres <br />TSDF Q Consolidated Manifest (VER C LIST <br />veizgteea Oil. Irtc. ® Oil Inc. - Davis Evergreen Oil, I:- - Frosno n Tine Out 4 <br />6880 Smith Ave. ❑ 4139 N. Valendt� art Properly Labe[Cd <br />Newark, CA 94560 Davis, CA 95616 Fresuo, CA 93722 ! Y <br />CAD980887418 CA0982446974 CAD987A4681 nuintion Stan bate Markcd <br />Bvergreen Erry Svc. I— t)B,Lte- MsDsl-1 ouse Keeping - Tank/Drum Cican <br />16604 S. San Fedro L. 1 5747T Wast Betterav{a LJ ❑ Other Services Checkrxl: ❑pit,ilters/D it Antifreeze <br />Carson, CA 90746 Santa Maria, �CA 93454 ❑ Called in other services needed ❑ Oil, r ters/Drunrs, p Antifreeze <br />CAn981696420 CAD982446858 <br />Source:ollectidn Station ®GOvelniment Oenelator certifies that it has established a program to reduce the volume, or <br />quantity & toxicity of the hazardous waste to the degree doWinined by <br />❑Marine ❑ �Ctlltural ®Industrial generator to beeoonomicallyptacticabte. <br />I herebyc1dfythat I have pati have the Odftk <br />hind the abs - gogotor to the terms 0n she reverse <br />sid 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 cusromer 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 requited 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 />These inclu& more strin leaf: detection and prevention requirements, engineering certifications of tank integrity, and financial aswrances for <br />closure an cc' ntal m es.is 1 ful ed 1 to out-of-state f rlities that comply only with federal used oil management standards <br />and not e re strip e t i tits. i o c on is for inf9tYxt on urposes o <br />atu nt ams Route # to erator s Signature Print 10nie Dat <br />white <br />