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_ WORK ORDF,,,9ERVICE AGREEMENT <br /> Evergreen Environmental Services N° 473093 <br /> J,v)irmed ro the p,'n+ernon of the enviraemenl <br /> To schedule a pickup, call Send payment to: Sales Order# <br /> 800-590-9455 Gvergrcen Oil, Inc. <br /> 6680 Smith Ave.,Newark,CA EPA#CAD982413262 P.O. BOX 30517 / <br /> 1664o S.San Pedro St_Caraao.CA EPA#CAD982413262 Las Angeles.CA 90030-0517 Date: <br /> GENLRATOR/JOB LOCATION BILLING INFORMATION _ <br /> SH clll:cx <br /> NAN F t#sryrFtt.JA NAME ❑ <br /> ADDRESS ADDRESS IL <br /> CL1ST(VIER CODF.NO. <br /> 37rJ CL <br /> CIT ' SPATE ZIP CO. CITY STATE ZIP CO. PO III <br /> PIIO,'E NO. PHONE NO. PROFILE' NO. CUST031ER EPA ID NO. <br /> y t I G nr z <br /> PRODUCT' WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil.Non-RCRA I luardous Lubricating CA221Rj�7 Gat. <br /> W"Ic.Liquid Industrial CA221 Gal. <br /> lard:te Solids anm,Sludge,, <br /> CA 134 Gal. <br /> u'n,i w <br /> RQ\\'Nv 6mM•aink l.yu'W\O.$.SA U?31 Gal. <br /> IY).i III oj,l l ,n,i,xt.IUAwll.l RXIIII'M12 <br /> Oil&Water.Non-RCRA Hamrdous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Drained Used Oil Filters Drum <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum <br /> Empty unions Douro <br /> Transportation Hes. <br /> Nan HamixIous Water Gal. <br /> Glycol Bulk SfU50 Go]. <br /> Glycol Bul Conc Gal. <br /> TEST: Clar n Tech 40(&*—� ppm ❑Clor D Tech ICXXI jilass.❑Fail n Halogen DeicclnAFlame Test ❑ ass ❑Fail <br /> Field Service Work Description: Total Charges <br /> Other. <br /> Other: <br /> t <br /> ccs Tion OnSim Off Sitc OI'I'Load Stam DII Load End Return In Y' 1 <br /> Consolidated Manifest <br /> n Oil.Inc. Eceritreel Em.Sea E••ergrenn Env.Svc. ❑ A)S Filterth A,c. ❑ Road 30B ❑ 4139 N.Valentine 15171 Clark Ave. <br /> Nes\'ark.CA 94560 Davis.CA 95616 Fresno.CA 93722 Industry.CA 91745 <br /> CAD9811887418 CAD9S2446871 CAD982446882 CADIX)(0)7432 <br /> ❑ Fvcrgrcen En.See. ❑ E\'ergreen Env.Sec. [D CFR 0CFR ❑ Greenleaf Lnv.Svc. <br /> 166114 S San Peda .A W' <br /> W . 745 ust Bcucr:mia 944 E.Slauunl Ac. 33210 Wemcm 3474 Tavun Circle <br /> Carson-CA 90746 Santa Mon....CA 9454 Los Angeles.CA Vint 1 Union CityCA 94587 Valley Springs.C\95352 <br /> CAW816964"f!' CAD98'_44685H CAL06511tN)21 CAUNK09i Ny? CAL6(X)21441I <br /> Generator cenilics 111.1 it has established a program to reduce the volume or <br /> Source: CIC011ection Stat1011 ❑Government quantily&toxicity Of the hlanrduus wa la tilt decree docnuincd by <br /> ❑ Marine ❑ Agricultural ❑ Indwitrial generator to he economically praclicahle. <br /> 1 hereby rtify that I have read and have the authority to <br /> hind the above listedeneralnr to the terms on the reverse <br /> Retain sample # - side of this form. <br /> IMPORTANT NOTICE REGARDINC THE DISPOSITION OF YOUR OIL. <br /> Per California Health and Safely Code Section 25250.9. Fcenneen helehv advices cuclomci that cuslonJer's shipntenl of used oil 1111p he <br /> oan.9)orted to a Iilillity that 15 retplired it)comply N'ilh liderd I'eg Ul:ll itnlz applicable to la:maLJlnCnl nil used oil. but Iltal I, not I'Cf11.11'ed IU <br /> comply \+ith the mom suingenl myuirrmenta applicable to haearcl11ps waste ul:utagentc'nt lacilitits. Culili rnin faCIIIIII!i 'll Iti111d1C oY 111'ncc1.' used <br /> old an' rcyuind 111 00'91 those 1.unr svhw nl reyununcntc and ,'11111 O1.1-1.l'.t 1 luhtic Ih a place.. u. -d old aL4 m hose uyuuuu nil n. <br /> 'I hent include more slim tilt Irak der•eliun and ple\enllun leyuil c malls.en Inc rim eclldic.uunU or Ink In _rite 1 d tams d iINSU1,111CCI Iia' <br /> cl s rc nnJ au Wend ;el.a,,, m Il Is Llul 11. send 1.1111 1111 it ,1.l ,I l.ue t tcihtl h.21 1olol ly ool\ o ilh let -"d uxyl old nlun't_.nnml '1nn11ard. <br /> aqJ 1.t Ihe.r nuns .vine.m rcyuirt`nxns. This nutilic;aion is for inlormaliun pyn'rose, oil - .. <br /> I)r err i :1111 -- — <br /> Rnulr 4 D:nr rncrdtor s til_n;Eure Print \;un,• D:1.. <br /> ti 'd tB02LLb602 UIN DNEIW/WI -i UDZUW WAIS di'0 :2I BO 52 des <br />