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10/0812010 10:16 FAX) P.0391045 <br />WORK ORD+ CEAGREEMENT <br />Evergreen Envimnmental Services <br />la - 558034 <br />dsdded to the protection of the environment <br />To schedule a pickup, call Send payment to: Sales Order #002 7 UZ <br />800-596-9455 Evergreen ail, Inc. <br />6850 Smith AVe-, Newark, CA EPA# CAD9a2413262 Dept. LA 2.3234 <br />16540 s. San Pero St, Cain. CA BPA# CAD9824.13262 Pasadena. CA 91185-3234 Date:__-- <br />r_vwvv ArrnutanTt T.ArATWIN BILLING 1NFG TION <br />V <br />I:. <br />■ 'u ■ <br />Used oil, Non-RCRA Hazardous Luludeating <br />CA221 <br />Gal. <br />Waste, Liquid wastrial <br />C,A221 <br />CW. <br />u.dA®Mt9VtAWltnrere,Mn-acsw—d— <br />V%tewI 9ffi.NA <br />a j i <br />PHONE NO, <br />all & Water. Non-RCRA Hazardous Wase EAquid <br />CA223 <br />Gal. <br />Non Hazardous Water <br />4"+a®DUCB <br />AST <br />CODE NUMBER <br />QUANTITY UN8&S PRICE AMOUNT <br />- <br />Used oil, Non-RCRA Hazardous Luludeating <br />CA221 <br />Gal. <br />Waste, Liquid wastrial <br />C,A221 <br />CW. <br />u.dA®Mt9VtAWltnrere,Mn-acsw—d— <br />V%tewI 9ffi.NA <br />CA134 <br />R1D1R6 <br />tial. <br />Gal. ..�....oe <br />all & Water. Non-RCRA Hazardous Wase EAquid <br />CA223 <br />Gal. <br />Non Hazardous Water <br />Gal. <br />Waste Solids and Sludges <br />GaL <br />Wash Out <br />Each <br />Press= Washer/Stearn Cleaner <br />Day <br />Transportadon <br />Fuel Sunt m. ut:t <br />Glycol Bulk 5OWSpedfy <br />% <br />dal. <br />Glycol Bulk ConcJBpecify Product <br />m <br />all. <br />TEST- ® Clot D Tech 4000—ppm <br />® Clor D Tech 1000 <br />❑ Pass Q Fail �w- <br />Retain sample # <br />Re aired Q <br />Field Sarvicc Work Description: <br />Other. <br />Other. <br />Total Charges <br />TSDF onsolidated Manifest <br />r qtr n oil, lac 6ve�een 08, lwx - Davis ® Bverg,.ett 411, inc- - Faesno <br />LTJ 6880 Smith Avc u Road 308 4134 N. Valentin® <br />Newark, CA 94560 Davis CA 95616 Fresno, CA 93722 <br />CAD98OW418 CAD�82446874 CAD982446882 <br />Bveegleen !3P <br />v. Svc. ® - n <br />uu 16b04 S. San aden 74 A Wei Betteravia l� <br />D IVEI2 C `E LIST <br />Time I T"imc Otic <br />TanklDrum Properly Labeled <br />Accumulation Start Date Marked <br />❑ Boase Keeping - TnnWDrum Clean <br />❑ Other Services Checked; O Oil, 13 Filters/Drums. 0 Antifreeze: <br />volume or <br />Source: ❑ CO1leettOA Station ---® GUVB . ant Generawr certifies that it has established a m to reduce the <br />quantity & tem k ity of the hazardous waste to the degree dp+&� by <br />Q Marine Q Agricultural aSdustdal generator to be economicaily practicable. <br />I hereby certify tbat Y have read and ltaYe-�e.ratblQ>ril1-t� <br />d the above listed a W4tor to the terms on the reverse <br />IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br />Per California Health and Safety Code Section 25250.9, Evergreen hereby advises customer that customer's shipment of used oil ma 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 />oil ere required to meet those mote stringer[ requirements, and some Out -Of State facilities that process used oil also meet those requirements. <br />These include more strirn[��ant Irak dckGot30 and prevention requirements, engineering certifications of tank integrity, and financial assurancels for <br />closure and uceiderrtsi releases. It is lawful'to 8ettd used oil to out -of -stale facllities the comply only with federal used oil management standards <br />raid not these mats stringent requisem nts. This notification is Yor information pu ly. <br />LZ <br />Driver Signature Print Name Route # Date Generator's Signature Print Name Date <br />Iae1.1— n...... 01..1. 0 V-11— I Iva - M_e^.nrue=Gaenh rn meniteat . tinction nAm/--nevar nnrw <br />