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<br /> WORK ORDER/SERVICE AGREEMENT N°_ 9 5 0 3 6
<br /> vergreen Environmental Services
<br /> / Evergreen Environmental Services N2 6 2959 �/ Conted rued s—aces
<br /> dedw—d to lee pmreurwr Jrhe enrimrmn,r dn(icnled rn fhe prmerriwr Irhe em•imrrmenr
<br /> To schedule a pickup,call Send payment to: Sales Order# C_ $g T schedule a pickup,call Send payment lo:
<br /> 800-972.5284 EKgeeeeOil,Ine. Sales Order#,40,0.4 j�
<br /> 800-972-5284 RoIpceo Ul.Inc. asap smahge kewam cA EPn4 cn _
<br /> baso snare A\i..Newark,cA aen,r Gv9axasy2ba Dept LA 23234 lasso s.sae Pcdo ss.,Cmsoa,G ePAx1aAp9szal22b2 Dep.LA 23234
<br /> laa6z Pasadena CA 91185-3234 Dater" _ Pasadena,INFORMATION (S
<br /> 2.13 Date:_
<br /> GENERATOR/J(HI LOCATION cAO9azJ BILLING INFORMATION C,ENERATOIUJOB LOCATION BILLING INFOIiMAT'ION
<br /> N 16 NAA E
<br /> Mg NAME CASH 1]CHECK❑ - CASK❑cucc(1]
<br /> AD
<br /> ADDRESS ADDRESS --- CU$TOafB CODE NO. ADDRESS C M R RNO.
<br /> __ GO _,_ Cl Y 5 CO. TTY STATS 'ltP- CO. M#•IT STATE ZIP CO.C[TY STAIR ZIP CO. 1N)#
<br /> PHONE NO. ZOr PHONE NO. PROFILE NO. CUSTOhfrsR EPA NNO. P NF•O. PHONE—NO. 1'ROEILF.NO, CI15fOMER EPA ID NO.
<br /> f ) ' (-ObOei '6
<br /> WASTE MANIFESTPRODUCT WASTE MANIFEST UANTtTY UNITS PRICE AMOUNT
<br /> PRODUCT CODE NUMBER QUANTITY ON] PRICE AMOUNT CODE NUMBER O
<br /> Waste Lmea Pain(N-in,A)
<br /> Used ml,Non-RCM xezallouv Lubdraring CA221 �L Gil \Nene lues Peier(NoeRCRA)
<br /> ¢,Liquid IMuanid G221 Gel. are Paim Relined MFl eln hk,oil based) -
<br /> CAI34 OSI. Wnne Pain,Rdia,,1(Flammabms oil based)
<br /> A'A,6Gal. are Aemsois Cans
<br /> Oil&N'mu,Nwr-RCM Ha adwr Nava Li9uid CA223 Gal. "'- -- -
<br /> NmHazudoua\Vuu
<br /> ____.. '— waste Coolant li9uidv,nu.s. - -
<br /> WazreSolidsaMsludgev Wane Flenunable Liquide,no.s
<br /> Wazb Om Each \Yea's Flammable Liquids,n.o.x.
<br /> Ne Washubream cil,su _ Day Non-RCRA Haz°Meas el-.
<br /> Nov RCRA Nin—Wazm,Liquid - -
<br /> Tnospona6on Waz,e'Ibxic Liquids w Salias(Clear 9)
<br /> FLelSmchvge _-_ % Nene Oxidizing Liquide or Solidv
<br /> Glycol BUR lseaaSprzdfy Il,aO, G.I. oohed USW Oi,nI._
<br /> (:Tyrol Bua meApaify Pmdatt Gal. .._. Empty -
<br /> T�ST.. Cbr pSecn4WU 1ppm ❑0orle—Fl0a Pesa ❑Fail Non lfawdous\lSrer
<br /> Total Char es Non HaraNmn WR.
<br /> Retain sample# Nw xaaamws seed, -
<br /> Re Hired won xaramm,a soeaa
<br /> Field Serviee Wmk D—JIN n: _ Glycol Bulk W.
<br /> Olncr: Glycol B°Ik Cane.
<br /> •rS Consolidated Manifest DRIVE CHECKLIST — _-
<br /> BvarBmenoil,ma R Wilma..r>,waI�Qrerareen oa.la°-Pearl❑neem nor am
<br /> 6fi80Amm Ave ❑R 0208 LJ IJ9N lSlemiae TOTAL exARGIs
<br /> Newmk,CA 94560 pav CA 95616 N oo,CA 93)22 ❑TantNmm[Topesly Inbckd TSDF
<br /> CAD9,aser,18 06-eli4 G0982446g82 ❑Arcumulmsm S,so Doe Mmked 1'-IE n0I1 Inc SA Rery hob I
<br /> ❑.l�I P,aergmenEm Sss. ��II BaBm,WBuiznkt®❑ ❑Home Keep,ng TmWmm Clean 6885 ,hAve. 1)210\Neuse El—
<br /> Cm.
<br /> 166045 sen PWm...LJ.i45AWe Ben ❑Other senxes Chedcd'OOd,.O.FIRNO ..OA-frc -k ad CA 44560 an GrJ.CA 9<S8i --- -- - - - - -
<br /> Canty,6990)96 Santa Afana589954 ❑Ca11W maM1usmirezomkd Od. F'i rsN A bete CAn98�8i418 GL0W34a530
<br /> CAD981fi9 U CAD98244645g Gmuarm 1-onsilw wbbsnedebog sed rhe vola m SOIIICe:❑Collection Station ❑Go\Rmmen[ 0 f h n ablL hN P 8 d he. Imeor :.
<br /> Source: Collection Station ❑Gove—at gaemiryBrnxrcnyof as Awmdwa wan_ Nc dogma deremuneA by Marine San uYarwmryof 0u huzvNona worts toN deet dnemnned try
<br /> ❑Moine ❑Aglieultural ❑Indusmal geemtm°bC efppp1B1veY paNk°Ne ❑ ❑Agdcuitural ❑IRdusuial Smoot b<ermmmkranr Pmaamnle.
<br /> I11s�DY ro n t l b- a h 1h Ih'it I z Y h t 1 h ad os a have tb—Hu i In
<br /> hj dIA le, 1�1 I d�q�fac to to teups°n the re pa,
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<br /> Hated lar tv the terms onrev Retain sample# ids°r,lakf
<br /> Weaf tele Porte. ars IMPORTANT NOTICE REGARDING THE DISPOSITION OFYOUR OIL.
<br /> IMPORTANT NOTICE REGARDING TETE DISPOSITION OFYOUR OIL. Izer California health and Safety Cade Seetian 25250.9,Evergreen hereby advises nntomer,hat customer's shipment of used oil ma be
<br /> Per CRIlfornin Healtb and Safety Code Section 25250.9,Evergreen hereby advises coap.oc,that cuclom *shipmem of used ori maybe ansporled to n fncnity that is required to cam 1
<br /> p y with federal regulationc applicable w managgement of used oil,but that is not required to
<br /> naysported to afaciliry that is required to comply with federal regmfians applicable to management of used oil,but that ie vol requiredm reply with the mine slringen[ quirements applicable fohazmdous waste mynagement fazilitia.Califomia facilities that handle or
<br /> 1 h the more nrin i t I ble to hazazdous wrote meso r facilides.Califomia fazilities c at 1�adle u' ss used Ioare n�,.-M-
<br /> G
<br /> )sed m men Those m trio en[re u' mrnts,mad some out-of-state facilities that rocess uaM oil also mxl thou re process usrA
<br /> c p y wit gen r—Moen s app sca g °ce
<br /> Al are y�ired m meet those more ahingenl requirements,arW some outof-slate facilities that process used nil al in req ts. .n r ist Son and These reel more olm, leak detection and prevention requirements.engineering cenifieations tank ince y, d f tial assuretaud for :, Nsureaul to send uxd eccidenml releases It is lawful to send used od to out of amts facai5es drat comply and vlth fWe mI management shndmdsandm is for mfmma,ion ori pry on y with£Neel uxd od,nmregemenl srandazd
<br /> FF p plus y
<br /> §nd these more shingrnt requirements The,notaficetion u for inf ration pwpoxs only s. au
<br /> z-13 S2
<br /> I (gnatum Print Name Route# Date Generator's Si Print Name Date Dever Signature Pnnt Name Route# Uate Generator' ignaal flint Nae Date
<br /> MR.Cow=Customer Cow-Pink aYskw Copy=Olfica Us.-Green Go ABach sl-Golden Copy=Driven Cow '..
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