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WORK ORDERISERVICE AGREEMENT Evergreen Environmental Services NO Q 14 6 7 dedicated to the protection of the environment To schedule a pickup, call Send payment to: Sales Order 860-596-9455 Evergreen Oil, Inc. 6880 Smith Ave., Newark, CA EPA# CAD982413262 P.O. BOX 30517 16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Los Angeles, CA 90030-0517 Date: Gs GENERATOWJOB LOCATION BILLING INFORMAATION til z WASTE CODE AM-NIF'EST QUANTITY UNITS NM, IBER NAME CASA ❑ CHECK ❑ AjTVS a LZ r ADDRESS CU T ER CODE NO. CIT ' STATE ZIP SCO. CITY STATE ZIP CO. PO # . Oil & Nater, Non-RCRA Hazardous Waste Liquid PHONE NO, Gal. PROFILE NO. CUST051ER EPA IDNO. Z, PRODUCT WASTE CODE AM-NIF'EST QUANTITY UNITS NM, IBER PRICE AiNIOUNT Used oil, Aron-RCRA Hazardous Lubricating Waste, Liquid Industrial CA2 CA221 Gal. Gal. a Evergreen Env. Svc. AJS Filter 4139 N. Valentine 11 15131 Clark Ave. Used Acttet>Mtirt Antifreeze, eta:-RCRA Ilaia &. Waste LI u 3 CA 134 Gal. CAD980887418 RQ 11v— Conbustib!t Ll,:, . N.O.S. NA 1 3 ill Od mrtamiaated with hafosrns CA221 FaaI/M Gal. Oil & Nater, Non-RCRA Hazardous Waste Liquid CA2 Gal. Waste Solids and Sludges Gal. Wash Out Each Drained Used Oil Filters Drum Aron-RCRA Hazardous Waste Solids (oily debris) CA223 Drum Empty Drams Drum Transportation Hrs. Non Hazardou Vater Gal. Glycol Bull: 50/50 Gal. Glycol B Cone. Gal• TEST: Clor D Tech 400dA�&ppm ❑ Clor D Tech 1000 Pass ❑ Fail ❑ Halogen DeteclortHame Test ass ❑Fail Field Service Work Description: Total Charges Other. Other: ices Time Vacuumtd— Out of On Site Off Site Off Load Start Off Load End Return Yard d TS [t Consolidate=d Manifest Evergreen Oil, Inc. 6850 Smith Avc. Evergreen Env. Svc. Road 30B a Evergreen Env. Svc. AJS Filter 4139 N. Valentine 11 15131 Clark Ave. Newark, CA 94560 Davis, CA 95616 Fresno, CA 93722 Industry, CA 91745 CAD980887418 CAD982446874 CAD982446882 CADt>M7432 : Evergreen Env. S Evergreen Env. Svc. CFR CFR Greenleaf Env. Svc. 16604 S. San P ro 745 A West Betteravia ❑ 944 E. Slauson Ave. ❑ 33210 Western 3474 Toyon Circle Carson, CA 9046 Santa Maria, CA 93454 Los Angeles, CA 90011 Union Ci} CA 94587 Va11eyy Sppringgs, CA 95352 CAD98169 ' 0 CAD982446858 CAL000110D21 CALQI507 CALW0214411 Generator certifies that it has established a program to reduce the 016me or Source: 6Collection Station D Government quantity & toxicity of the hazardous waste to the degree determined by ® Marilie ❑ Agricultural Ll Industrial venerator to N, -economically practicable. I hereby certify that I have read and have the authority to a�� bind the above listed generator to the terms on the reverse Retain Sampleside of this form, DIPORTANT NOTICE CARDING 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 our of state facilities that process used oil also meet those requirements. These include more stringent leak detection and prevention requirements; engineering certifications of tank integrity, and financial assurances for cls pre and accidental releases. It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards a d lot these more stringent requirements. This notification is for information purposes only.