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1010812010 10:13 fAX) P.0331045 <br />WORK ORDOSIERVICE AGREEMENT <br />12 <br />'Ang. Evergreen Environmental Services <br />MU. <br />NP 550967 <br />dedicated W c <br />the protetion of the eavirownent <br />To schedule a pickup, call Send payment to. Sales Order # <br />800-596-9455 Evergmft Ou. Inc. <br />6880 Smith Ave.. N&wask, CA EPA#CA13982413262 Dept. LA 23234 <br />16540 S. San Pedro St., Carson, CA EPA# CAMS2413262 Pasadena, CA 91185-3234 Date: <br />PRODUCT <br />f <br />WASTE <br />CODE <br />h1kNIMT <br />NUMBER QUANTITY <br />UNITS PRICE AMOUNT <br />Used oil. Non-RCRA Hazardous Lubricating <br />CA221 <br />On]. <br />Waste. Liquid hidustriaL. <br />CA221 <br />cal. <br />Used A%MdWt1ftAfitMtff,1b. KOUMZ" KnAriaus <br />W#MlAuid <br />CAI <br />GaL <br />R D.S. NA <br />FOCOAU%2 <br />GAL <br />Oil & Witter, Non-RCRA Hazardous Waste Liquid <br />dA223 <br />Gal. <br />Non Hazardous Water <br />Gal. <br />Waste Solids and Sludges <br />Gal. <br />Wish out <br />Each <br />Pressure Wulied5team Cleaner <br />Day <br />Tnuisportation <br />A401 sure hane <br />% <br />- <br />Glycol Bulk pacify Product <br />Gal. <br />Glycol 8uV,!w,15pscl[y Product <br />TWT, (Clor D Tab 4000—ppm Ej Clor D 7beh 1000 Pus ❑ Fail ❑ Pass E] M <br />Retain sample# <br />Required <br />Field Service Work Werlption: <br />Other. <br />Other <br />Total Charges <br />TS Consolidated Manifest 6,1VER CHECKLIST <br />Out I= -Davis[:] E 0' Rum" 13 7ime to Out <br />4 " P Z — <br />Z'6E'8r8(=-1h0AiZr 1-1 'R'1'5 MOW" 13 MNIentZ <br />Num roparly La <br />mr Davis,Daviv, CA 95616 CA 93722 13 TankfDrum Properly Labe ?6 <br />Accumulation <br />5'. <br />CAD982446874 In Date M <br />46CA 94560 <br />$S7418 &W 2446882 Ll Accumulation Sian Date Marked <br />®House Keeping - Tank/Druni Clean <br />-sim"'tD ... <br />1:1 '1'6604 'v MA -WIN titeravil 0 Other Services Chcckcd: 0 Oil, L3 lFilters/Druins, 13 Andilrec7c <br />sarim Mft* CA 93454 <br />F <br />-S Sau P <br />Carson. <br />A 9 <br />a n. <br />CAD98169 <br />169 0 CAD932446859. 1[3 Called in othcr.scrview; nectlod U Oil, C) riltcrstDLI! �_,Antlftcc7c <br />Generator certifies that it has established a program to reduce the volume or <br />Source: ;tCollection Station ❑ GOVeEriment quantity & =kity of the hazardous waste to 0a degraii, determined by <br />ZI Marine U Agrictilturat Q Industrial gwmtor to be economically practicable. <br />ItAreh^cert that I have read and have the authority � <br />hind the above listed generator to tho Iffma on the rMLqrgj <br />side of this form, <br />IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br />Per Callibrnin Health and Safety Code Section 25250.9, Evergreen hereby advises 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 management of used oil, but that is not required to <br />comply with the more stringent requirements applicable to hazardous waste management facilities. California facilities that handle or process used <br />'EinI an aired to meet those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements, <br />elude more stringent leak detection and prevention requirements; engineering certifications of,tank integrity, and finnacial assurances for <br />.'U"; Faccidental releases. It is lawful to send used oil to out-of-state -facilities th4x�ly only with federal used oil management standards <br />and ntthese more stringent r1ments.7his notification is for informatfori . purp son <br />nature Mint Name Route # Date - JCWn6rator's Signature 'Print Name <br />