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1010812010 10:19 f AX} P.0451045 <br />WORK ORD &ERVICE AGREEMENT <br />ASEvergreen ental Services 2 580295 <br />dedIcared to the protection of the envimirtnent <br />To schedule a pickup, call Send payment to: Sales Order # <br />800-596-9455 Evergreen oil, Inc. <br />6880 Sinith Ave., Niiwark, CA SPA# CAD962413262 Dept. LA 23234 °� r <br />16540 S. San Pcdro St., Cnt'son. CA SPA# CAD987AI3262 Pasadena, CA 91185-3234 Date: <br />Used oil, NrnrRCRA Hazardous Lubricating <br />CA22 <br />Gal, <br />Waste, Liquid Industrial <br />CA221 <br />Gai. <br />u Auoot nadttme,Norft=AViamdow <br />CAI <br />Gal. <br />WW& mow CambaU&ft Ugnld,NAS. NAI <br />t <br />Gal. <br />to t ®Nand w <br />Oil & Water, Pion-RCRA Hazardous Waatc Uquid <br />CA223 <br />Gal. <br />Non Hazardous Water <br />Gal, <br />Was;w Solids and Sludges <br />Gal. <br />Wash Out <br />Wa <br />Each <br />Pressure Washer/Steam Cleaner <br />_ Day <br />Trans on - Hrs. <br />Fuel surchup <br />Glycol Bulk 50/ peclly Product Gal' <br />Glycol Bulk neJSpecify Product G°l <br />TEST: Chn D Tech 40 to ❑ Clor D Tech 1000 Pass ❑Fail <br />Retain sample <br />e uired <br />Field Servire Work Deaeription: <br />Other: <br />Other: <br />Consolidated Manifest I DRIMR CHECKLIST <br />)rverl{reen Oil, In <br />fivet ettoil;lne.-Davis® Evergt n Oil, tnc. -Fresno ❑ Tinic 11+ 71111C Oil( <br />6680 Smith Ave.1:1 Road 3013 8139 N. Valentine ❑ Tana/Dnun Properly Labeled <br />Nm;t CA 94560 DA& CA 95616 Fresno. CA 93722 <br />CAD980$87418 CAD 82446874 CAD982446882 ❑ Mctmntlatiwt Start Dtttc I hirked <br />®IIvergreen Env. Svc. Eu Fea%j=-SasaNb&® ❑ Hnu� I uepillg - Tuns;/Drum Clean <br />16604 S. San 74 A West Hettsravia ❑ Othcr ScrvicQS Checked: O Oil. Q 1,ilwr;4/Drums, ❑ \ntil'rw'ry <br />Carson, CA 907 Santa Maria, CA 93454 ❑ C;lllcd in anter Fer'iC0 tiecded Q Oil. Fillers/Drums. 0 Antifrawe <br />CAD9816 CAD982446958 <br />Generator certifies that It has established a program to reduce :he volume or <br />Source: Collection Station ®GOV@IlllCleni quantity & toxicity of the hazardous waste to the degree deteratittdd by <br />® Monne 0 Agricultural ❑ Industrial generator to be economically practicable <br />X her certiPv that have read and have the authority to <br />jiInd thea nye listed generator to the terms on the reverse <br />side of this form, <br />HAVORTANT 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 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 die more stringent requirements applicable to hazardous waste management facilities. California facilities that handle or process used <br />oil are required to meet those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements. <br />These include more stringent leak detection and prevention requirements, engineering certifications of tank integrity, and financial assurances for <br />sloe and accidental releases. It is lawful to send used oil to out-of-state facilities the only with federal used oil management standards <br />an no these more stringent requirements. This notification is for information pu s only_ <br />D er Signature Tint Name Route # Date orator' lgnature Print a e DOe <br />