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10/0512010 10:19 fa P.0441045 <br />A WORK ORDASERVICE AGR W -AT NT <br />Evergreen vi talei `ces N2 584931 <br />dedicated to the pnoteetton Of ilia envfrowneq j <br />To schedule a plckup, call Send payment to., Sales Order <br />800-596-9455 Evergreen Oil, Inc. <br />6889 Smith Avo., Newark, CA EPA # C-AD9gy4137 2 DW, LA 23234 <br />16540 S. San Pedro St.. Carson. CA EPA# CAD9s2413262 Pasadena, CA 91185-3234 Date: <br />GENERATOR/JOB LOCATION BILLING INFORMATION <br />PRODUCT <br />WASTE MANE EST <br />CODE NUMER <br />QUANTITY UNITS PRICE AMOUNT <br />Used oil, Non-RCRA Hazardous Lubricating <br />Waste, Liquid industrial <br />CA <br />CA221 <br />Gat. <br />Gal. <br />Waft�wurnAart+w-RCRAHaa®d-us Aquw <br />CA134 <br />,r4 <br />Rowes caa �tatamda. N ax t� aPJAI <br />t iMUL <br />. 4 <br />CITY SFATE1P <br />CO.'; <br />Gal, <br />r. n <br />Gal. <br />Waste Solids and Sludges <br />Gal. <br />Wash Out <br />Each <br />Ptessure Washer/Steam Cleaner <br />Day <br />PRODUCT <br />WASTE MANE EST <br />CODE NUMER <br />QUANTITY UNITS PRICE AMOUNT <br />Used oil, Non-RCRA Hazardous Lubricating <br />Waste, Liquid industrial <br />CA <br />CA221 <br />Gat. <br />Gal. <br />Waft�wurnAart+w-RCRAHaa®d-us Aquw <br />CA134 <br />Gal. <br />Rowes caa �tatamda. N ax t� aPJAI <br />t iMUL <br />Gal. <br />Oil & Water, Non-RCRA Htaardous Waste Liquid <br />CA223 <br />Gal, <br />Non Hazardous Water <br />Gal. <br />Waste Solids and Sludges <br />Gal. <br />Wash Out <br />Each <br />Ptessure Washer/Steam Cleaner <br />Day <br />Transportation Z <br />Hrs. <br />Fuel Stntharge <br />% <br />Glycol Bulk 50/ Specify Produrt <br />Gal. <br />Glycol BulkA=JSPec1fy Productrr- <br />OOFGal. <br />TEST: Uf Clor D Tech 4 m ❑ Cior D Twb 1000 <br />Pass ❑tail <br />Retails sample # <br />Required <br />Feld Sei-Ace Work Description: <br />Other: <br />Other: <br />Total Char es <br />TS Consolidated Manifest DRIVNQCHECKLIST <br />Evergreen 011, ins. Eveagreen0i1.loc.-Davis® Ever mn Oil, Inc. - Fresno p Time in Time Out <br />6880 Smith Ave ❑ l2.oad 301; 4139 N. Valentine <br />Newark, CA 94560 Davis CA 95616 Fresno, CA 93722 d Thak/Drum Properly labeled <br />CAD980887419 CADJ82446874 CAD982446882 CI Accumulation SUM Dute Murked <br />�i Evergreen Env. Svc. ®E tOl,ittc-SMIXTh® fD House keeping - Ttnk/Dnrm Cleun <br />LJ 16604 S. San Ped 74.5 A West Senernven 0 Other Services Checked: Cl Oil. ❑ riher.JDnlm%, 0 Anliftcozu <br />Carson, CA 90 Santa Madil. CA 93454 <br />nA violr.� nAT%n Q9AAAQ9Q 10 Called in other servicos needed n Oil. r-1 rilterr•/Drtuns. rl And <br />20 <br />Generator cenifles that it has established a program to reduce the volume or <br />Source: XCollection Station ❑ Government quantity & toxicity of the hazardous waste to tate degree determined by <br />❑ Marine ❑ Agricultural ❑ Industriall generator to be economically practicable. <br />I hereby MZfl v that T have read agd have the authgZjLy to <br />bind the above listed generator to the terms n the reverse <br />side of this form. <br />IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br />Per Califerhin 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 requited to <br />,omply with the more stringent requirements applicable to hazardous waste management facilities. California facilities that handle or process used <br />-ire required to meet those more stringent requirements. and some out-of-state facilities that process used oil also street those requirements. <br />include more stringent leak detection and provention requirements, engineering certifications of tank integrity, and financial assurances for <br />•ad accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br />ee more stringent r uirements. This notification is for information purpos <br />Print Name Route # DatePffettiorWignature Print N Date <br />n. m......., -n....0 1M-1.O^"I--1i-- ^----^--.. Aa --LL --. --S- -• - - I -----.. —1.1.../..1.1 <br />