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a <br /> WORK ORDL,;'SERVICE AGREEMENT <br /> i Evergreen Environmental Services NO 454662 <br /> ledir pled to prmrrrinn of the environn ew <br /> To schedule a pickup, call Send payment to- Sales Order# <br /> 800-596-9455 Evergreen Gil, Inc. <br /> 6880 Smith Ave.. Newark.CA EPA#CAD982413262 P.G. BOX 30,917 . I� <br /> 16540 S.San Pedro Sl..Carrion.CA EPA#CAD982413262 Los Angcics. CA 90030-0517 Date: Y� <br /> GENERATOR/JOB LOCATION BITAJNG INFORMATION <br /> tR <br /> NAME. CASH CHECK El:ss • ADDRESS CUS'T'OMER CODE NO. <br /> C���/ <br /> CI'I.1STATE ZIP CO. CITY STATE ZIP CO. PO It <br /> ONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA 1D NO. <br /> 9) 177-3374 t n.afo xYLI <br /> PRODUCT WASTE MANIFI-IST QUANT'IT'Y UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil. N'On-RCRi\ IlazartlouN Lubricating CA_.. Gal. <br /> Waste.Liquid Industrial CA221 Gal. <br /> Gal A-1:1Y—AiutC—..1,,ryen-RCRA 16nµw. CA I3 Gal. <br /> N'uv[t' iJ <br /> RV W.'n 0mn .l.k l.yuW.N.OS.IA l:A??I Gill. <br /> rW O III foil nmin,nxi J will lel, - RXIIpiXI'_ <br /> Oil G Water.Non-RCRA Harardmu Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out E.nch <br /> Drained used Oil Fihcrs Drum <br /> NIm-RCRA Hazardous Waste Solid.(oily debris) CA223 Drum <br /> Emply Drums Drum <br /> Trmsspowainn Hes. <br /> Non liavanluus Water Gal. <br /> Glycol Bulk 50/50 - _ Gal. <br /> Glycol Bulk Corn:. Gi4K <br /> TEST❑ Clor D Tech 4000 plan ❑Clor D Teeh I(NN❑Pass❑Fail Q Halogen ocloelor/ft. c Test ❑Pass ❑Fail <br /> Field Sen-ice Work Descripriol: Total Charges <br /> other: <br /> Other: <br /> Vacuum Scrri s'I'inm <br /> Clain\'c On site oil'Site-Oil Load Stun Ori Land End-Return '• it <br /> I'S , <br /> Consolidated Manifest <br /> Fcemrwn Oil.Inv. 1:1hoogwon Gtr.Svc. ❑ Everpeen Env.Svc. O AIS Filler <br /> Smith Ave. ]fai811 e Road 3011 4139 N.Valvoline 15111 Clark Ave. <br /> Nee;u'k.CA 94560 Davis.CA 95616 rrecnn.Ci 937?2 Indu.trc.CA 917.15 <br /> CAD9908874 IS // CAD982446874 CAD98'_44688'- CADR100 7432 <br /> C1 1>s eraren late.S" Fw,e been Lov.Svc. ❑ Cl It ❑ CFR ❑ Gracale;r Bur.SOV. <br /> 16(dN S.San I\J III 45:\\\'vu Bcucraria NJ F.$..noon.4rv. 2111\\Sslvrn i "I Inn Circle <br /> (arson.CA%7�1fi Santa Mann.CA 93154 Lm Aulwlee.CA 90011 l!nion Cin.CA 9.1597 Valley Sprin-'.CA 95352 <br /> C:kl)9816961]iT CAD93244615.\' CAIJXXII 11X)221 CAL(XM41i07 CAL(I30114II <br /> Generamr ccnilics that It Inas oslabli bed a prograin to reduce the%Ihanc or <br /> Source: C011eCtion Slatioii ❑CJO\'erntnenl yu:uviI\& union, Ol the hazankms tea,lc Io the d{arm dctenuinvd br <br /> :1 iVlill'l llC' ] Agricultural C] Industrial ^eller:lil.r to be c.unumicalk prirlicahle. <br /> -- 1 here... certify that 1 have read and have the authorih to <br /> Retain sample #_IO L 3 bind the above listed ecnerator h1 the terms on the reverse <br /> side of this form. <br /> 11NIPORTANT NOTICE REGARDING THE' DISPOSITION OF YOUR 011— <br /> Per Calirnrnia Ileallh and Safely Code Section 25250.9, Evergreen hereby' advises C01111nncr thal cuss MCI S shipment oI used Oil uun he <br /> u'ansptmed to a larility that is required to Comply \I Jill I:Jcrll t'egulettiuns applic;lhle to nwn:c'enlenl of used oil. but Ihm is not required to <br /> Conti+ V6111 the alone strim_eal reyuirtmrnls nlipliCANC to haim'dnu1 lade management Iacililies. C:lilinnia lacilitie. Than handle Or ponces used <br /> ,,it are wgtulCd to Intel those nwre ltlllueClll n•qulrCOMItS, and sums om-oGNl:uc I:IC'llltlb that prncesS used oil aha nlecl those Icquirrnlents. <br /> .1'hca inrludc more su'ingout Icak Jetectiun ami prevention requirenrcnts. eq•incel'in_ certilications ol'tank inleeriq'. :md financial a>Nurallccs lir <br /> close l• ;Tail :KCidclUll rClC;lse+. II is la"Tul to end Itself ell to out-of-stove IiIcililics illat C'Oluph• 0111. 1\'1(11 ICdarlll osCa Oil IltanaglFnldnt standards <br /> and 1 q These ntnrC stringent requirctltelnS. -I hi= notil C:11ian is 101 jnlimn;ai1 n purposes OI - <br /> fhiler Si..... lr: Prim Name Rnutd d Date GelICralur� SieIMILOC Print Nam,: Dale <br /> L 'd b8O2LL4602 HIN 0N3W/WI1 HOZHW WAIS dSO :2T BO 92 deS <br />