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1 WORK ORDS SERVICE AGREEMENT <br /> Evergreen Environmental Services NO 7 6 9 6 <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: Sales Order# <br /> 800-972-5284 Evergreen Oil,Inc. <br /> 6880 S ith Ave.,Newark.CA EPA#CAD982413262 Dept,LA 23234 <br /> 16540 .San Pedro St..Carron.CA EPA/CAD982413262 Pasadena.CA 91185-32.3=1 Date: 1l <br /> GENE RATOR/JOB LOCATION BILLING INFORMATION <br /> NADIR NAME GASH❑CHECK❑ <br /> ZALY 605LU # <br /> ADDR ESS ADDRESS CUSTOMER CODE NO. <br /> � �fFzaC Lily t2.,►a <br /> CiTY STAT . ZIP CO. CITY STATE. ZIP CO. PO# <br /> --sz C. C 53 Cq <br /> PHO.'S E NO. PHONE NO. FPR0FII,E NO. CUSTOMER EPA ID NO. <br /> t51 ?1-t ���i22 � ► I1 � ,Crat,tCr � <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NU'%IBER <br /> Used o h Non-RCRA Hazardous Lubricating CA221 Gal. <br /> Waste.Liquid Industrial CA221 Gal. <br /> t,e.1 Aut: .,t—Amt—re.Som RC'RA H.vynt,xie CA 134 Gal. <br /> N'a,te Li id <br /> RQ%%u ombugihle Liquid.%10.S NA CA221 <br /> M1111. d a,wwmumwdwiihhdoeemt H701/1-11i2 Gal. <br /> Oil& `ater.Von-RCRA Hazardous Waste Liquid CA223 Gal. <br /> Non H zardous Water Gal. <br /> Waste olids and Sludges Gal. <br /> Wash qut Each <br /> Pressuic Washer/Steam Cleaner Day <br /> l R o-X ,, LI zS <br /> Trans nation Hrs. <br /> Fuel St rcharge % <br /> Glycol 3ulk 50/50/Specify Product Gal. <br /> Glycol 3ulk ConcJSpecify Product Gal. <br /> TEST: Clor D Tech 4000_4)pm ❑Clor D Tech 1000 ❑Pass ❑Fail <br /> Ret tin sample# Total Charges <br /> Re wired <br /> Field S!rvice Work Description: <br /> Other: <br /> Other: <br /> TSD ❑ Consolidated Manifest DRIVER CHECKLIST <br /> Et rgreen Oil.Inc. Evergreen :1nOil.Inc.Inc.-Davis Evergreen Oil.Inc.-Fresno Time In I Time Out Oco <br /> LJJ 68 0 Smith Ave. ❑ Road 30B ❑ 4139 N.Valentine <br /> Ne xark,CA 94560 Davis,CA 95616 Fresno,CA 93722 ❑ Tank/Drum Properly Labeled <br /> C D980887418 CAD982446874 CAD982446882 ❑ Accumulation Stan Date Marked <br /> ❑ Ev-rgreen Env.Svc. ❑ Boym01Lhc.-SmSkirit❑ ❑ House Keeping-Tank/Drum Clean <br /> 16 04 S.San Pedro 745 A West Betteravia ❑ Other Services Checked: ❑Oil. ❑ Filters/Drums. ❑Antifreeze <br /> Ca son.CA 90746 Santa Maria,CA 9454 <br /> C D981696420 CAD982446858 ❑ Called in other services needed C3 Oil. p Filters/Drums.❑Antifreeze <br /> Generator certifies that it has established a program to reduce the volurne or <br /> It <br /> e: ❑Collection Station ❑Gavemment quamiq&toxicity of the hazardous vva.ste to the degree determined by <br /> L] Marine 0 Agricultural Industrial @enerator to be economically practicable. <br /> I herebv certifv that i have read and have the authority to <br /> bind the above listed generator to the terms on the reverse <br /> side of this form. <br /> IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. <br /> Per Calif mia Health and Safety Code Section 25250.9,Evergreen hereby advises customer that customer's shipment of used oil may be <br /> transporte I 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 w th the more stringent requirements applicable to hazardous waste management facilities.California facilities that handle or process used <br /> -il are req Ared to meet those more stringent requirements,and some out-of-.state facilities that process used oil also meet those requirements. <br /> Fhese incl ude more stringent leak detection and prevention requirements,engineering certifications of tank integrity,and financial assurances for <br /> closure an I accidental releases.It is lawful to send used oil to out-of-state facilities that comply only with federal used oil management standards <br /> and not th se more stringent requirements.Th�s notification is for information pur;iro <br /> ses nly <br /> (c/5n6� <br /> 1 <br /> Driver Sig ature Print Name Route# Date or's igna re Prinl Name Date <br />