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1010812010 10:14 fAX) P.0361045 <br />WORK ORDAERVICE AG "T <br />4Evergreen Environmental Services NO -554920 <br />4.la dedicated to die pmeacdon of the environment <br />To schedule a pickup, call Send payment to: Sales Order # <br />800-596-9455 Evagreen Oil, Inc. <br />6890 SIrdthAve., Newark, CA EPA CAM324137.62 Dept. LA 23234 L—L <br />IMM S. San Pedro St. Camut, CA UPA#CAD9924L3262 Pasadena, CA 91185-3234 - Date: cc�. <br />GENERATORIJOB LOCATION BILLING INFORMATION <br />PRODUCT <br />WASTE MANIFEST <br />CODE NUMBER <br />PA' 15A <br />Used oil, Non-RCRA Hazardous <br />Lubricating <br />eat <br />Waste. Liquid <br />Industrial <br />CA221 <br />Gal. <br />Used Aummadva AMR=M NORACRA HnWdM <br />Wom UaWd <br />CA134 I <br />Gal. <br />It 6 <br />Oil & WaMr, Non-RCRA Hazardous Waste Liquid <br />PRODUCT <br />WASTE MANIFEST <br />CODE NUMBER <br />QUANTITY UNITS PRICE AMOUNT <br />Used oil, Non-RCRA Hazardous <br />Lubricating <br />eat <br />Waste. Liquid <br />Industrial <br />CA221 <br />Gal. <br />Used Aummadva AMR=M NORACRA HnWdM <br />Wom UaWd <br />CA134 I <br />Gal. <br />NA <br />Oil & WaMr, Non-RCRA Hazardous Waste Liquid <br />CA223 <br />Non Huard= Water <br />CAI. <br />We= Solids and Sludges <br />Cial. <br />Watt Out <br />Each <br />PreamwasherlStaun Cleaner <br />Day <br />—iWnspormdon <br />P4 <br />Ha. ,000 <br />i Fuel surcharge '000or <br />Glycol Bulk pecity Product <br />GAL <br />Glycol au!K6ucJSW* Product <br />10 Gal. <br />TEST, Rf Clor D Ted 40OZ9—ppm <br />Clor D Tch 1000 ZP-. <br />El Fail <br />Retain sample # <br />Required <br />Field Service Work Description: <br />Other: <br />Oftr: Z7 Lz-- <br />Total Charges <br />TS Consolidated Manifest - Fmsno o Inme jr, DRI CHECKLIST <br />Everg�aa Oil, tom. v __T 1co I <br />11 M"MU" - "s El 4E137XN7V2mjZ- im <br />Newark, CA Davis CA 95616 Fmno, CA 93722 0 TanklDrum Properly Labeir <br />CAD980887418 CAr;82446874 CAD987A46882 0 Accurnulation Stan Date Mar -d <br />E] E � EEnv. S 0 Howse Keeping - Tank/Drum C1 n <br />Ig -n <br />S. Sa ,, vg <br />r El 7a4?A=WCwt It na'2mr ENV hia" E 1 1:3 Other Services Checked: 0 Oil. ms, 0 Antifreeze <br />Carson, CA 9Q?U Santa Maria, CA 93454 — --.— — ^:I — — <br />Generator cierti6es that it has atablisbed a program to reduce the volum or <br />Source: Collection Station LJ Government <br />quantity & toxicity of the hazardous waste to the degree detaimined by <br />Madue Q Agficultual Q Industrial generator to be mokwmically practicable. <br />Lhamby-cWy-thgliLLhave —read qnd have gm-awhority LQ <br />Idadibe -above listed generator to the terms ons verse <br />side of this farm <br />IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br />Per California Health and Safety Code Section shipment of used oil may be <br />transported to a facility that is required to comply that is not required to <br />Section <br />"y w <br />2 <br />with 0* <br />federal <br />complywith&=stringent requirements appl, rem 'e to hazardous wasto management facilities. Ca(ifomia es that handle or proms used <br />oil am r 0i t those more stringent requi e8 meet those requirements. <br />on <br />rr <br />7bose hic re sningent leak detection d ventlo and financial assurances for <br />ut enta releases. It is lawful sen use oil management standards <br />I III d <br />closure dja�qphid� 11 <br />an <br />and not the ore stringen=ts. This roti&cation is for information purposes o <br />ZM 5; <br />Driver nature Print Name Route# Date Mig—nature Print Ifan% Date <br />