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10/17/2005 10:50 FAX 2098969624 J&B KINBROUGH Q1002 <br /> L <br /> WORK ORDER smviCE AGREEMENT <br /> Evergreen Envirt nnlenW Services W 2 8 7 8 7 5 <br /> ±S Y dedicated to the protertinn of the environmeni <br /> To schedule a pickup, call' Send payment.to: Sales Order# 78? <br /> 800-972-5284 Evergreen OR,Inc. <br /> 6800 Smith Ave.,Nowak CA EPA#CAOM413262 P.O.BOX 678252 <br /> 16540 S.San Pedro St-,Carson,CA EPA#CADW2413M Dallas,TX 752675252 Date: <br /> GENERATORIJOB LOCATION BILLING INFORMATION <br /> NAME CASH O CHECK❑ <br /> p <br /> ADD ADDRESS CUSTOMER ODE NO. <br /> L CITY STATE CO. STATE ZIP CO. PO# <br /> PHONE . PHONE NO. PROFILE NO. CUSTOMER EP.$]XL-N0. <br /> i_ <br /> PRODUCT JCODE <br /> MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> NUMBER <br /> Used oil.Non-RCRA Huzard0us Lubricating 7 'Gal. <br /> Westc,Liquid industrial Cal. <br /> u,ra�,a.�lowlere.. -acaw asr,rros. Cl.' Z andWwawo fbiobiwak L%w,.l N.0.5.HA Gal. <br /> -uo ROil tit Water.Non-RCRA Huatdous Waste Liquid Ctd. <br /> Waste Solids and Sludguti Cra1 <br /> Ll Wash Out Each <br /> ( Drained Used Oil Filten Drury <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Dram <br /> Empty Dmms Dnnla <br /> V.f..— -rransp rtu0on �' <br /> Non Hazudous W- Cril' <br /> Glycol Hulk 50150 <br /> i_ Glycol H Conc. +� Gal. <br /> TEST: Clot D Tech g00ppm ❑a D Tech 1000 pai9 0 Fail ❑ Hatollm Demelor/H3me Tont Pass ❑Fail <br /> Field Service Wark Description: Total Charges <br /> r <br /> Other: <br /> Odrer <br /> s Varvum ices Time <br /> Out of ud On Site 'Off Site Off Land StaK Off Lmd End Ram m Yard <br /> TS Consolidated Mantles <br /> L Evergrero Oi4 IDc. Evergrxn Env.Svc. Evcrgre Env.Svc AJS Filter <br /> 6880 Smith Ave. Read 30b 4139 N.Valentine 15]31 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Industry,CA 91745 <br /> CAD9808874t8 CAD982446874 CAD982446882 CADOW097432 <br /> ` ❑ Evergreen Env.S Evergreen Env.Svc. ❑ CFR CFR F7 Greenleaf Env.Svc. <br /> 16604 S. San P 745 A Wrst Bvtmmvria 944 b.Slauson Ave. 33210 Western 3474 Toyon Chole <br /> Carson,CA 46 Smia Maria,CA 93454 Lae An roles,CA 9MI1 Union City,CA 94587 Valley Sppnnttttgs,CA 9$352 <br /> CAD9816 CAD9S2446858 CALi>(> 11(1021' CALOOD091507 CA 14,411 <br /> (venerator certifies that it has established a Program to reduce the volumn or <br /> Source: Collection Station ❑Government quantity&inxicity olit-111 tit 17,a dow wute m the dclirce detemmned by <br /> ❑Marine ❑ Agricultural ❑ Industrial gene a or ld be econ ally p actiwblc. <br /> I hernh cert" at I have read and have Use authority to <br /> bind the abffthted genctrator to the terms on the reverse <br /> Re in sample # side of • 1. <br /> Driv ature tit Name cute# Date a tor' Sign Print Name ate <br />