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1010812010 10:10 f A)D P.0281045 <br />WOP.K ORDASERVICEAGRMMENT <br />Evergreen Emironmental ServicesN-0 544747 <br />det7ee ared to the pit eeetion 9f the envimatpie'Rt ? . <br />To schedule a pickup, 'cail Send paynaimt to�f � :"ajes Order # <br />800-596«9455 Evergreen oil, Inc. - <br />hBBD Smith Ave.. N*"Wk. CA SPAM CAD9824132e2 Dept. LA 23234 <br />16540s. Sats poem st., cornua, CA Pim cAD9sa4t3aba Posadetts. CA 91195-3234 Tate; c- '�-.'— <br />C.14;.NW.RATnR1I0R LOCATION BILLING INFORIMUTION <br />PRODUCT <br />WASTE SIA ST QUANTITY <br />CODE NUMBER <br />UNITS PRICE <br />CASH ® CHECK <br />�, ` <br />r I . I : ' •'' ice. F <br />Gat. <br />CW: <br />t. <br />ADDRESS4 <br />CA 134 <br />ADDRESS <br />CUSTOMJIR CODE NO. <br />x we.m CcxrdwNiWe taquW u.p s, �w <br />wMikW me <br />AMA <br />Gal. <br />CITYSATE <br />ZIIP CO. <br />CITY <br />STA QIP GO. .AO # <br />Non Hazardous Wbtcr <br />4 •` r `t k <br />Gall. <br />�.. <br />oIYE iVO.I t <br />Pi?lU E NO. <br />P P1f><.t>< NO. , : CUS MMR EPA ID NQ. <br />ivheh <br />Pmmuree WgshWgUn rn Cleaner <br />PRODUCT <br />WASTE SIA ST QUANTITY <br />CODE NUMBER <br />UNITS PRICE <br />AMOUNT <br />[lard oil, Noe-RCRA HaautxdauK Lubricating <br />Wantc. Liquid Industr l <br />CA2.2 is <br />CA221 <br />Gat. <br />CW: <br />t. <br />uNa nawmmr.a ArMfeeme. Mm.RCnw Al mrwm <br />CA 134 <br />Gal. <br />x we.m CcxrdwNiWe taquW u.p s, �w <br />wMikW me <br />AMA <br />Gal. <br />oil A Water, NorrRCRA HaiWous Waste Liquid <br />CA223 ' <br />Gal. <br />Non Hazardous Wbtcr <br />Gall. <br />Wase Solids and Sludps <br />Oil. <br />Waah Out <br />ivheh <br />Pmmuree WgshWgUn rn Cleaner <br />Day <br />7bunsp nation <br />Hrs. <br />NO) Surchatga <br />gds <br />Glycol Bulk SDe50lSpecify Produ°t <br />t7at; <br />Clywal Bulk ConcJ3 uct <br />t3ai. <br />TEST: [ Clot D Tech 4D(Kl......,:._ppm ® Cior D itch 1000 ® Pan ®licit. Paatrs Q Fail <br />Retain !sample # ; <br />.Required { <br />Pield Stra;vice Work O®acription: <br />Other: <br />Other: <br />Total Chat es <br />.• <br />TSDF [] Conpolidated Manifelit DRIVER CI�ECKLINT <br />Bvorgrean Oil.'nc. Ej 110M en (1i1, tax. - Davis Ever�r@xn OII, Presno Time Iter r(t <br />688D Smith Av¢. Rgad ,3 11 4139 Ai. Valontiac <br />Newarit. CA 94964 Duvig. CA 95616 t'M. no, CA 93722 M 111rnk/Drum Properly Lalkied <br />CAD980997419 CA0992446874 CAD98 2 p Accumulation Start niite Marked <br />113Mrg ori Env. Svc. ® 00.1nr.•& MWIlalk[D Houw Ketprnl; - Tank/Drum Gleam <br />lMiU4 S. San Pedro 7 A West Be�eravia Other Servis e% Choked: C3 Oil. ❑ NiltcrJDrum... O Antiih.ea.e: <br />Carson. CA 90746 Santa Maria, CA 93454 O Called in wher avrvieoi neaied Oil. }=16tCra/l ruhtr. p Antifrcime <br />CADY91696420 C.AP98244s5838 li 17 <br />I t=tor cenities that it has rttablishe i a program to reduce the valuing firSource: ®Collection Station. Q t; t�r+elitni<ent <br />quundly & wxicity of the lumur0ous waxtc to the depee determined by <br />Q Marine Q Tictlltural Q InduStri81 generator to be econamicully pnnaicable. <br />Lhumbx-seclibthat I have read and have thT rite to <br />Wad the ®have listed generator to the ternm ora najxnm <br />aide of this loan. <br />IMPORTANT NOTICE REGARDING THE DIS TION[ OF YOUR Oil... <br />Per California Health and Safety Cade Section 25250.9, Evergreen hereby advises customar that customer'; shipment of uced nil may be <br />transported to a facility that ire required to comply with federralres uladons applicable to munegamens of used oil. but that is not required to <br />comply with the more :stringent requiraments applicable to hazardous waste man4$emcat facilities. Caliromiat facilitieK that handleor prcx brors ua:d <br />oil are required to motet those more strinprit requirements, ural some out-of-state facilities that proccm used oil altio meet those reyuireatnant4. <br />These include more stringent leak detection and prevention requirements, engineering eeni>icationx of tank integrity, and financial aacs.uraaaccs for <br />closure aad accidental reicanes• It it lawful to send used oil co put -of -state facilities that comply only with federal used oil management standards <br />and not these more pttfirigent rm4uirmetnts. This goelcatlon is for Information purposes only. <br />r <br />Driver Sigaiaturc Print Name Renate # Daae ` Generator's Signature Print Name Date <br />