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m® ��Tp=e �^ �^ j �}7® yHg�.a p��@t Services �•T`f'AEBZ �J�AV.A3'1'JA®.O Ll EJdt.P A\_.l.e ®�`+-S AWJ:Jt/Pi1.t1 t swnKe-rg 4 err Er\ --1lie iat IJ V..�Ci4.CS 0,00.0 dedicated to the pro4w, of the environment To schedule a pickup, call Send payment to: Sales Order # 800-596-9455 Evergreen Oil, Inc. 6880 Smith Ave., Newark, CA EPA# CAD982413262 Dept. LA 23234 16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Pasadena, CA 91185-3234 Date: f C.F.NFRATOR/IOR LOCATION BILLING INFORMATION NAME NAME CASH [:] CHECK ADDRESS i��,�, ADDRESS CUSTOMER CODE NO. rm. 4 CITY STATE -4 ZIP CO. CITY STATE ZIP CO. P # PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. PRODUCT WASTE CODE MANIFEST QUANTITY NUMBER UNITS PRICE AMOUNT Used oil, Non-RCRA Hazardous Lubricating CA22P —` Gal. Waste, Liquid Industrial CA221 0 Gal. Used Automotive Antifreeze, Non-RCRA Hazmxlous Waste Li aid CA 1 4 •{. . - i '``• _ k-_''— _ . - Gal. RQ Waste Combustible Liquid, N.O.S. NA 1993 111 (Oil contaminated with hula ens' CA221 F001/F Gal. Oil & Water, Non-RCRA Hazardous Waste Liquid CA223 Gal. Non Hazardous Water Gal. Waste Solids and Sludges Gal. Wash Out Each Pressure Washer/Steam Cleaner Day Transportation Hrs. Fuel Surcharge % Glycol Bulk 50/SQ/Specify Product Gal. Glycol Bulkone./Specify Product Gal. TEST: £Clor D Tech 4006--=x'" ppm ❑ Clor D Tech 1000 Efpass ❑ Fail Retain sample # _ Required Total Charges Field Service Work Description: Other: Other: TSD1R'=I � Consolidated Manifest Evergreen Oil, Inc. ❑ Evergreen Oil, Inc. - Davis Evergreen Oil, Inc. - Fresno 6880 Smith Ave. Road 30B 4139 N. Valentine Newark, CA 94560 Davis, CA 95616 Fresno, CA 93722 CAD980887418 CAD982446874 CAD982446882 DRIVER CHECKLIST ❑ Time In Time Out ❑ Tank/Drum Properly Labeled ❑ Accumulation Start Date Marked ❑Evergreen Env. Svc. EveipeenOil,Inc.-Santa Maria � ❑House Keeping - Tank/Drum Clean 16604 S. San Pedro ✓ 745 A West Betteravia ❑ Other Services Checked: ❑ Oil, ❑ Filters/Drums, ❑ Antifreeze Carson, CA 90746' Santa Maria, CA 93454 CAD981696420-' CAD982446858 ❑ Called in other services needed ❑ Oil. ❑ Filters/Danns, ❑ Antifreeze r Generator certifies that it has established a program to reduce the volume or Source: 0 Collection Station ❑ Govemment quantity & toxicity of the hazardous waste to the degree determined by ❑ Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. I hereby certify, that I have read and have the authority to bind the above listed generator to the terms on the reverse side of this form. IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. Per California Health and Safety Code Section 25250.9, Evergreen hereby advises customer that customer's shipment of used oil may be transported to a facility that is required to comply with federal regulations applicable to management of used oil, but that is not required to comply with the more stringent requirements applicable to hazardous waste management facilities. California facilities that handle or process used oil. are required to meet those more stringent requirements, and some out-of-state facilities that process used oil also meet those requirements. These include more stringent leak detection and prevention requirements, engineering Icertifications of tank integrity, and financial assurances for closure and accidental releases. It is lawful to send used oil to out-of-state facilities that complyonly with federal used oil management standards and not these more stringent requirements. This notification is for information purposes only. Driver Signature Print Name Route # Date Generator's Signature. _ Print Name Date