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U WORK ORDh�ERVICE AGREEMENT <br /> i Evergreen Environmental Services NO- 472871 <br /> dMirnred rn rhe proracliun of rhe emilownenr <br /> To schedule a pickup,call Send payment to: Sales Order # <br /> 800-596-9455 L•verglcen Oil. Inc. <br /> 6880 Smith Ave..Newark,CA EPA%CAD982413262 P.O. BOX 30517 <br /> 18540 S.San PMro Sr,CRrsnn.CA EPAN CAD982413262 Los .Angeles.CA 900.,0-0517 Date: <br /> GENERA'I'OR/JOB LOCATION BILLING INFORMATION <br /> N :IE NAME CASH Q CHECK❑ <br /> �sa9k # <br /> r ADDRESS CIJ,ST'ONJER CODE NO. <br /> ADDRESS L <br /> J � <br /> CITY STATE Air CO. CITY STATE ZII' CO, PO# <br /> -LI Z <br /> PHONE NO. PHONE NO. PROFILE NO. Cl1S"I.OhlER EllA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used nil.Nnn-RCRA Hazardous I-uhricating CA2 "]{' 7,�i(..� Gal' <br /> Wnslc,Liquid Industrial CA221 Gal. <br /> li».1 nwmmt.-.awrwm•,nx�-xc'xn nix:waw. CA 134 Gal. <br /> wam i.0 <br /> 1Q3WI., Tk IiV-'.NllS.N.\ 119amxI, Gal. <br /> I W 1 III IfNI��nlannnML wad IAtnMTei - <br /> Oil&Water.Nan-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Oul Fuaeh <br /> Drained Used Oil Fillers Drum <br /> Nmr-RCRA I lamrdons Waste Solids(oily debris) CA223 Drum <br /> hnquy Iliums Drum <br /> 'frantipltnatian Ulm. <br /> Non Hazardous\Va Gal. <br /> Glycol Bulk 50/50 <br /> Glycol Bul" Cane. Gal. <br /> TEST:ff Cloy D Tech 1 ppm ❑Clor D Tech 1(10(I_. Pass❑Fail ❑ Halogen Detecwr/Flantc Test Pus ❑Fail <br /> Field Sen•icc Wnrk Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum vices"rink / <br /> Out aland On Site_Off Site-Ofl Load Stan OI'r Load End Return to Y- /✓ <br /> TS F . Consolidated Manifest <br /> Es'eremen Oil,Inc. Ev'rgrcon Env.Svc [:] Evergreen Fal Svc1:1 AJS Filter <br /> 68811 Smith Ave. Rrr 3094139 N.Valentine 15131 Clark Ave. <br /> Newark.CA 91560 Davis.CA 9.561(3 Rrwo.CA 93722 Industry,CA 91745 <br /> ('AD99(1987418 C'.AD982446874 CAD992446882 C'.ADO(X)097432 <br /> ❑ Erarercen F n.S Evergreen Enc.Svc. ❑ CPR ❑ CFR Gm4'1m Env.See. <br /> I6(dIJ 5.S:m P• ru 743 A N'es1 Bclt`avis 944 E.Sbuwn Ave. 3321(1\Vcvlcrn .1474'1 mon Circle <br /> Carson.CA )( 46 Santa Vlaria.CA )3454 Los Angeles,CA 91X711 Union Chy.CA 94537 Vallov S�lrinas.CA 95352 <br /> CAD9XIfi9(I 1) Ce\019144685% CAL06511(X)2l CAL000091507 CAI.IXXI_14J11 <br /> Generator ceniftes that it ha,established a program to reduce the volume or <br /> Sou— <br /> Collection Station ❑Government quuntilp& wxicitc ,I the Iwnlnlaus waew w the dcurre J•IennineJ by <br /> ❑ Marine ❑ Agricultural LlIndustrial 011101alor to 1,e econwldculh practicable. <br /> hembc certify that I have read and have the authority to <br /> bind the above listed generator to the terms nn fee reverse <br /> Retain sample # I I C I side of this form. <br /> IMPORTANT NOTICE REGARDING THE DISPOSI'T'ION OF YOUR OIL. <br /> Per California Health and Safety Code Section 252511.9, 1'_cergrcen hereby ad5'ises cusulnler Ilial customers shipment nl used Oil 111m be <br /> Innlspoltetl 1,,a faciim thul is required to cony,], \cith federal regulations npplicuble to mmllagenxnt of used oil, bol than is not required to <br /> Comply with the Ilton` stringent requirentdnts applicable to hazardous waste manaL•enlent facilities. Cal IIornia iaciblics (hill bandle or process Used <br /> oil 'ac lequimd to nleil those Inow ]lliuge"I regaw'n"'a'. and sunt[urn-of store laeililies that PI'nr'CSS USC,] oil :Ilio I11CCI IiOSC 1'l`gnll'CI11CI11S. <br /> Th n include nnn'a sitin_ant leak dtmct ion and pre\ention ieLitmenieuts, engineering eertil iC:dinn>Of lank integnly. and financial asstuanee, lin <br /> L s u"e and aCCidenlnl releases. It is Ino lid to send used oil to out-ul'-.'lute f:milities that comply only with ftderd used nil Ill:ut,gcnx`nt suladald, <br /> :u I un these mote slringem ret{uircments.This notification in Inr infarnndiun pu - lses onlyLt� . <br /> l' <br /> l.IlM Pt . \dello tool, Y Daly x`I rah,r'. , r2nanu'e Print `::nor Darr <br /> S 'd bBOZLLb60Z dIN O213W/NI-i HQZHW NNls dbOtzT so SZ dos <br />