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WORK ORDER1,SERVI1C'E AGREEMENT <br /> 2 Evergre n Environmental Sguees NO- 273695 <br /> "AlL ate4 re) the prolec:lion of the ern i ron-nent <br /> Vit' Cdil selid pa.-.fnent to: Sales Ord-1, <br /> 800-972-5284 ()J. iTI, <br /> 6680.3mlth Ave,. Newark,Ck EPMCA0982413Q62 P.O. T40N 678,2.52 <br /> 16W 8 Sar)Pearo St., Ca on,CA EPA#CAD982410262 Wilas, TX 75267-9252 Date,, <br /> GENERATORIOR LOCATION BILLING INFORMATION <br /> N*IF, �ck H HECK <br /> I N-46-ME <br /> 1�1 3H Ill, <br /> �kD 6 E��S C1 �CODF NO <br /> Ir't ulkt�s APJ�)RES� j <br /> I I L441— <br /> —%�. <br /> C I JAXE ZIP CO,I CITY STATE ZIP Co. PO# <br /> PRONE NO. PHONE NO, PROFILE NO. CUSTOMER EPA ID NO <br /> I <br /> J, <br /> FRODUCI WASTE INIANIVEST QUANTITY UNM PRICE AMOCNT <br /> CODY NUMBER <br /> 1 <br /> NIII-RCF<A Hazard us Liibrwatin &U 9 <br /> 221 <br /> F- <br /> \Vasi.e,L.quid 1 illdutrialCA221 <br /> C1,134 <br /> G.1- <br /> Oil&Watet,Non-RCRA Har opus WaAte uquA G.I. <br /> r <br /> s and Sludpes Gdl. <br /> W'4�b Out <br /> Drum <br /> 1 Nv(i-FCRA Hazardous Waste )H&(oily debt CA223 <br /> Drums <br /> Nf-,t) Hafardoui r ater Gal, <br /> ........... <br /> 5060 I Gal. <br /> Glycol BUI CZ)Tlk I Coai <br /> TEST: Clot ri Tech 002 j1'%k-pprn Ll Clkw D Tub I(XX) la'--s❑Fail I <br /> Halogen Detector/Flame Test pas-' pw <br /> Feld Service work Desu)ptio 1: -Ct)Laj Charizcs <br /> ucit"It'n ard Ort Nice Ott Site Off Losidi�staq— Off Load End krturn to Yard <br /> Consolidated Manifest <br /> Evergreen Chi,Inc. FvuTeepi f."Tiv—svc. F-1 Everpteen Env.Svc. '---I A fS pliter <br /> 6880 Smitti Ave. Rnqf 306 L--, •413qL— <br /> 'N.Vulantine —1 o 1:i 1 ('10'.k Ave Ej <br /> CA 9450t) Dovis,CA 95616 Nrcjn(%( A 93122 lndu-,tn-.CA 91745 -----------------7 <br /> A CAD99244t.,874 CALY482446897 CAIX.9k)(197432 - <br /> Ever iFnv. S\c f" I (*iR 17 CFR Greenleaf Pnr Svc. <br /> 7d1 A ; Beneravia .-1 944 1", Slamon Ave. — 31210 WeNtern I—J 3474 Toyon Ci le <br /> Carson, 94f, Santa Miria.CA 9.,4:)4 J,o.�A,inolc% CA 4W I i Llni,-n City. CA 94')8-, VAJIVi Sr(;MFN- ( A 031 2 <br /> 9 ( -'4-4 6 CAL00011002) CWN <br /> A1,f)(Y)(1415117 CAL4�11 <br /> �I )91 <br /> Lwnewor Certifies that it hVIS-.,SLal)jj8he(i 21 Dr,)gr3ffl TO VOVVe the volume or <br /> Source: 21 Collcctiur, Station :lGoverni-fient q'uantm. & toxici ,oof t1w)wardoij%wuslt:�o the dearer determined by <br /> ij Marine J Agricultural j Industrial irencrawi-to be OL'onorilicaiiy <br /> ......... I hereby vertu}' that I have read and have the allthcpritv to <br /> hind the—ak)(�17e listed generator to the terms on the reverse <br /> R -a ii sample side of this form. <br /> file"— <br /> Signature Vint�tN at-tie # ' <br /> D jj venerator's Signature Print Name Date <br />