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10108/2010 10:16 TAI) P.0381045 <br />WORK ORDAERVICE AGREEMENT <br />0 Al Eveigreen Environmental Services N2 555029 <br />dedicated to the protection of the envimnmenr <br />To schedule a plckup, call Send payment to: Sales Order # <br />800-596-9455 avetween oil, Int:. <br />6880 smith Ave.. Nowak, CA EP" CAD982413262 Dept. LA 23234 <br />16540 S. San Pedro St. Carson. CA "A# CA0982413262 Pasadena. CA 91185-3234 Hate, <br />GENERATOR/JOB LOCATION BILIANG INFO ION <br />1 <br />a <br />J. — : �LTY !� ttil :: . �� <br />11310 77 <br />EWA <br />i. <br />. <br />♦ y <br />• r <br />PRODUCT <br />r 1 , <br />1.11ij <br />11310 77 <br />. <br />i. <br />. <br />.TEST:2rclor D Tech 4OK&IOPPM <br />Clor Wrech fki 9 <br />•W E] Fail <br />Required <br />91 <br />TS Consolidated Manifest DR R CHECXLIST <br />fivergneen Oil, [ale. (�I 8 (Ai, Lx • MVIS ® BVn Oil, Inc. - Fresno ❑ 'Gime In_ Tis»C Out <br />6880 SmitltAVe I-1 R 30B �#139Valantiae ❑ Tank/Drum Pro erl Labeled <br />Newark. CA 94560 avis, CA 95616 Fresno CA 93722 P Y <br />CAb98D887418 CAD982446874 CAA9jx446$82 ❑ Accumulation Start Datc Marked <br />®B,, Svc ❑ Ev1l0�,faa_S>ualiV�ia®� ❑ liuusc Keeping-Tank/Drum Clean <br />16604 S Sen p 745 A W%t Bettenavia Cl Olhcr Services Chcckcd: ❑ Oil, ❑ FlterstDn;ms. ❑ Antifreeze <br />Cacaos, C4 9 Santa pp�,,�� CA 99454 - ❑Called in other services needed ❑ Oil, Filters/DruM9', " Amifrcere <br />CAD98 t CAA982446858 <br />SOUTCe: COIIeCtiOri Station a Generator eeetiftns that it has established a program to reduce the volume or <br />❑ Govemment quantity & toxicity of the hazardous warte to tho degree dowraitled by <br />❑ Marine q Agdeultural ❑ Industrial generator to be economically practicable. <br />-- - Lh&Uk certify that I have head and have the attthorl y t9. <br />bind the above Ilsted gger�,��to the �tiae reverse <br />side of alb&= <br />Il MIZTANT NOTICE REGARDING THE DISPOSITION OF YOUR O1Q♦. <br />Per California Health and Safety Code Section 25250.9, Evergreen hereby advises customer that customer's shipment of used oil may be <br />tra orted to a facility that is required to comply with federal regulations applicable to management of used oil. but that is not required to <br />tDith the more stringent requirements applicable to hazardous waste management facilities. California facilities that handle or process used <br />uired to meet those more strin4ent requirements, and some oat -of -state facilities that process used oil also meet those requirements. <br />7-1M 11.A11 QA-'1VWv0AW$4A <br />lude more stringent leak detection and prevention requirements, engineering certifications of tank inteoty, and financial assurances for <br />d accidental releases. It is lawful to send used oil to aut-of-state facilities that,"y only with federal used oil management standards <br />ese more stringers uiretnents. This notification is for information purpos only <br />Signature Tint Name Route # Date Generator's Signature Print Name Date <br />%&164.. l --. 191..1. O \/ 11 �... .•.--.. ♦1tl:-- t,-- is-.-- n-.... .... .,. .- .... . ,. , , .w ,.. .. <br />