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1010812010 10:12 (FAX} P.0311045 <br />WORK ORD&SERVICE AGREEMENT <br />Evergreen vie t Services ® 551399 <br />dedicated w the pnotection of the envimmnew <br />To schedule a plckup, call Send payment to: Sales Order # <br />800-596-9455 Evergreen Oil, Inc. <br />6880 Smith Ave., Newark, CA EPAO CAD982413262 Dept. LA 23234 p <br />16340 S. San PrAro SL, Carson, CA EP" C9A]D9824113262 Pasadona, CA 91185-3234 Date: ® /00 <br />GENERATOR/JOB LOCATION BILLING INFO ION <br />L <br />WASE <br />CODE <br />MANIFEST QUANTITY UNITS PRICE <br />NUMER <br />As 04 1 go - <br />Used oil, Non-RCRA Haznrdoaa Lubricating <br />Waste, liquid �M Industrial <br />CA22 <br />CA221 <br />Elk <br />u®mnucon-9-AP4(r a :, NwRCRA tbumdou <br />Wrdla <br />C:A134 <br />Gal. <br />Roo WaweQol9PWlpibis Liquid N Q S rdA <br />l993III �coanlol <br />1 <br />G• <br />Oil A Water, Non-RCRA Hazardous' Waste liquid <br />CA223 <br />Gal. <br />PRODUCT <br />_ <br />WASE <br />CODE <br />MANIFEST QUANTITY UNITS PRICE <br />NUMER <br />AMOUNT <br />Used oil, Non-RCRA Haznrdoaa Lubricating <br />Waste, liquid �M Industrial <br />CA22 <br />CA221 <br />all. <br />Ciel. <br />u®mnucon-9-AP4(r a :, NwRCRA tbumdou <br />Wrdla <br />C:A134 <br />Gal. <br />Roo WaweQol9PWlpibis Liquid N Q S rdA <br />l993III �coanlol <br />1 <br />G• <br />Oil A Water, Non-RCRA Hazardous' Waste liquid <br />CA223 <br />Gal. <br />Non Hazardous Water <br />Gal. <br />Waste Solids and Sludges <br />Gal. <br />Wash Out <br />_ <br />Each <br />Froum Washer/Steam Cleaner <br />Day <br />Transportation <br />Ms. <br />Fuel S <br />% <br />Glycol Sulk SONS ' Product, <br />Gal. <br />Glycol Do—conc./Specify Product ®® <br />Gal. <br />TEST, P6 Clor D Tech pm ❑ Clar D Tech 1000ass <br />❑ Fail ® Pasa ® Fail <br />Retain Sainple # <br />Required <br />Field Service Work Dt scription: <br />Othet: <br />Other: <br />Total Charges <br />Z6r80TSMh0A'U <br />Consolidated Manifest DRIVE HECKLIST.... <br />nc. !—f Ro 011, Inc. - Davie j` F.vereet► Oil. &ie.-FteauoaTime11>_TimeOut I ,.I u 413 l V lenrano <br />New <br />CA 94560 Davis, CA 93616 Ftasno, CA 93� 0 Ttuik/Drum Properly Labeled <br />CAD980887418 CAD992446874 CAD982446882 t7 Accumulation Start D:uc Marked <br />18v ea Env. Svc. C11,Ina-&'mMa{a❑ Q Hou -,c Keeping - Tank- ?rum Clean <br />L66 5. San Ped 7 A Wes4 8ettesavie p Otter Services Checked: 11011. 0 Fiiters/Drunis, ❑ Antifirceze <br />Carson, CA 907 Santa Maria, CA 93454 ,,-_-._-----.-_----_-•_-. _... _ .,.__.... <br />1 <br />1, <br />SOUTCB: Calleetiatl Station ❑ Govemtnent C7enerator certifies that it has established a program to reduce the volume or <br />quantity 8t toxicity of the hazcrdous waste to the deg= datetmined by <br />❑ Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br />C bereby carijfv t I have read and have the alt1;h0 'tv to <br />j Ltd the above_listed generator to the terms S10 theme <br />d{deof this form, <br />TIVIPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br />Per California Health and Safety Code Section 25250.9, Evergrwo hereby advisee 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 managgement f d cit, but that is not required to <br />comply with the more stringent requirements applicable to hazardous waste management facilit . C 'f a facilities that handle or process used <br />oil are required to meet those more stringent requirements. and some out-of-state facilities that ess s oil also meot those requirements. <br />T114110 include more stria eat leak detection and prevention requirements, engineering certificati of t to 'ty, financial assurances for <br />cl and accidental re eases. It is lawful to send used oil to out-of-state facilities that comply 1 wi e o went standards <br />of these more stringentrequirements. This notification is for information purposes only. 4 <br />gnature—Ptint Name ® Route # Date 15enerator's Si re Print Name/) Date <br />White rnrnr-r..natnmar r:nn„ - Pin1r a. V-11— f•nw„_nFfl .. 1 1.,., r^.....,.. n....... nrr....r. - ,.-��u �, n -,d _.. -_ n- --... <br />