|
9 0
<br /> WORK ORDER/SERVICE AGREEMENT N4 80875
<br /> Evergreen Environmental Services N°667116 � Evergreen Environmental Services
<br /> ded(rared eo dre p-JJre nni+ma„xnr Coal¢in,H,,d Serviees
<br /> dMirnred ro rhe Prwettiwr oJxhe wrvimnnirnr
<br /> To schedule a pickup,call Send Paynaew lo: Sales Order dj!2�_ i To schedule a pickup,call Send payment lo: Sales Order#A
<br /> 800-972-5284 Evem..oil.let. 800-596-9455 E,crgrcenCA,let.
<br /> CAD9gu13J63 Dept.LA 232M a L= &a0Sm1Ave.,.&,CA eP ,G as Dept.LA 23234 �j�/
<br /> rAa CnD9ex4i3363 Pasadena,CA 91185-3234 Pte: 14—/3 3x63 P sdcw,CA 91185-3234 DAR: !/
<br /> GENERATOR/JOB LOCATION BILLING INFORMATION GEN s s TOM cB LOCATION cn BILLING INFORMATION
<br /> MENAMECASK❑CrlECI(❑ NA NAME GSH[]CHECK t]
<br /> A DR S ` A ADDRESS ICES TOD9ER COUE NO. R - ADDIt155 C MF.R COIF.NO.
<br /> CSTATEZm CO.CITY STATE Zm CO. P()p STATK CO.CITY STATE ZIP CO. Pa.
<br /> — C -
<br /> fONENO. PHONE NO. PROFILE NO. CUSTOnfEN EPA�IgD NO. NENO. �> PHONE NO. PROFILE NO. _ MRR EPA ID NO.
<br /> PRODUCT -M MANIFESTQUAN'PITY UMTS PRICE AMOUNT PRODUCT WASTE MANIFECODE NUMBER ST
<br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT
<br /> Used oil,Nw�RCRA liaxeNuvs LubrknNe -CA2_2� LY'ro Z S Gel
<br /> Wine Lmex Poim(Nw-RCRA)
<br /> Wasle.L-A IMrmdal CA221 Gal. \Vasco Lamx Da.(N.RCRA)CA134 C.,
<br /> _
<br /> u.eaom.v,.ana,..e.x as x
<br /> \Vesta Pain Relaud(EYammabka oil buck)
<br /> adur,wce.w,uw,µwarzaa.ru �rir -'-' ”"-'_"_' ------'-'- \Vane Paint ReletM(Plnmmahinoil based]
<br /> s iv LatP.em.w�s,mea..m. Gei. --
<br /> ql&Wekr,Nw-ACRA HazvewvtYarte Lgvid CA223 Gal. \Vena Aenzak Cws
<br /> Non H-%11 -�--�--
<br /> Car _
<br /> \Yore Solids and ShWBn _ Gal. \VumC iw alive Liquids.rias -- --
<br /> \VashOm
<br /> _ _ ___ Nuts FlemmaDle L'prndx n.o.v
<br /> RezwrolNSMrlStewn Ckm,er � '.
<br /> _ DaY Wazte FWnmable L"prods,n.o.x ____.__
<br /> Nw RCRA xazaedwa%Vane,Liquid
<br /> hampwtmion Hrs. Nav-RCRA Nezeidwa Wmre,liquid
<br /> Fuel sumhwge % Waste Touc Liquids wSoiids(Clus 9)
<br /> Glycol Bulk 50/ paify Pmdrel GeL u¢Oxidizing Ui idsSolids
<br /> i Glycol Bvik %/Specify Pmdvtt Gol. Droved Used Oki Finers
<br /> Emily Dmnu
<br /> TEST. Gw DTeeh 4oWZ4Cdppm ❑CIw DTe<h IOW ffl., Feil Nw Hamrdou Water
<br /> Retain sample#/ Total Char es xw wmraam want _
<br /> Required Naa xmardoaa smiaa
<br /> Pield ServicetYah Dettripiom Nw Hannbus Solids
<br /> Env. Giywi BWk SlY50
<br /> Dine: .1,a sun cow,
<br /> TS ConxsBoliid�awd Manifest DRIVER C KLIST
<br /> 6880 SmiNOgvxM ❑Rina'on -1
<br /> N.Vaknnro-Fresno D'Itrael lime Um TOTAL CHARGES
<br /> N .CA9k5re Davi;CA 95616 Frewro,CA93]22 - ❑T kN Pmperlr Lnbvlcd
<br /> CAD980a8J41a CAD9824468r4 CAD982446a82 ❑A 1 S mr hlarlsd i TSDF ryry
<br /> U.IfiW45.San PNm.❑.]43Awev Bumm-❑ -.. _-__ aH % TmkrDmmClean .......❑685 Ax... .3320\Vm�nem.... ❑
<br /> -- C=CA 90]46 C=Maid CA 9354 0M1 S. ('Mkd❑OL'❑FI Slq ❑-f -.. hexad,CA 99560 Uvron Gry.CA 9458) ---
<br /> CAD98169N2 GD962446856 _._. ❑CIIM adDo. /D g\ rrceze CADY8088]418 CALOW3445W __
<br /> $Ol11Te: COIIeCtiOn Station ❑Government Gercm 'fie M1 M1v bl led pgram d sh wlmucw Genernwzrennea%not thus estublenMnpg dare tle vplvmem
<br /> qu uly& y fi iwz rdo temde drgree hmrminM by Source:❑ OIIection Station ❑Govenlmcnt &loxaiiy of drehazallous aauem Ne degree detiwinM bg
<br /> ❑Marine 0Aglieutlural ❑I13dostrial germmrmbbc ttonowrally practic bid [!7:El
<br /> ❑Aglicullural❑Lldustrial gem,morm mrronommnrypwfir.and
<br /> Lb blue the ialle lyIQ - -- I herchv cerlilYRLgtlhaYe.read e,d naye Ina mrthotity In
<br /> h bled the above Iisled emmrnlar a Ire%arms on thg
<br /> an ,ea,erar
<br /> .drlhiIJ1i_ Retain sample# bi
<br /> ,bleanmataca..
<br /> IMPORTANT NOTICE REGARDING TILE DISPOSITION OF YOUR OIL, IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL.
<br /> Per CBliforaia Ieallh anA Safety Code Sertlma 25250.9,Evergreen hereby advises cuuomer that customer's shipinenl of used oil m¢y be Per California Health and Safety Cade Section 25230.9,Evergrewr hereby advice•.customer[hal c..o 's shipment of used oil may be
<br /> uanspattdtoafe<ility lhaz urequired to comply wiN fedora regulatiamapplicaWeto mannggemm�t of usedbot mat is not required to ansponed toafaciliry that is regoircA to comply rvi[h federal rcgMations applicable to menagemutt of used nil,bin that is wtrequiredm
<br /> on ply win'he mom nringem requirements applicable m hmardous waalc mannFge.et facilities.Califomla hciliii.that bandic ar is used m�ply with the more shin an require s epplMnble to hazardous wa to management hcilities.Califumia facilities that hendie wmproc s usM
<br /> it..required m rncu(hose more nrinKtrcq qm¢u,and some out-oLsmm faziihies Ihnt Prose used oil also meet those requi els. cit required m,mecrl o m rin�conl q and some vuPof-stem facilities thin prose used oil also meet those requi es
<br /> C hemi ode mora striaggant leak detection nM prevemion requucmenu,engineering certifcahona of mak integrity,antl financial assurances for I these in luQe rliora sningcnt Teak de end prevention requirements,engirmu-ing ttnifceuons of tank inlegriry,and Hnamial nssurnnces for
<br /> closure accidenul releaser.lt u lawful to send used oil to out-of-state facilities Ihnt wmply only win f raI used oil menag landards closure Yds dental releases.It is Ira ai to sena rased oil to on[ror-alnm racilitira mal comply oNy wiN rrdaml aura oa managemem alanaards
<br /> mrd not ase more stringent reyurrerxnts Thu noh5cation is for mfwmetion pugwus only /� A and Nese g y it c tion t§for information p rposes only !
<br /> D er Slgna.,a Print Name Route# Dale mer oPs Signature Print Nnme Date J(/�.,[/� j
<br /> Whim Copy=Customer Coq•-PrNeBYellmv CopµOnma Use-Green CopY-Atlecnmmenihst Goldon cow=or rGopy I Dover Signature Print ane Route# Date CEnernlur's SiSnature Print Nmne Dt ,.,�.;#
<br /> WORK ORDER/SERVICE AGREEMENT WORK ORDER/SERVICE AGREEMENT
<br /> Evergreen Environmental Services N2652538 Evelgreen Envlronmeutal SI r lC s ND 6 $459
<br /> dedearsd ra rxrc nror 'w oJrhe enwronnrcnr �/ d t d rhepw! /rhe enrfm+
<br /> To schedule a pickup,can Send Palmlent to: Sales Oder O ��6 ! ,, 1'o -
<br /> sch d I a plCh paytitep
<br /> .cell S nd pt il: Splea Ordpr 5 � '�
<br /> 800-972-5284 13ergr oil Isc 800-972-5284
<br /> ro,N=..+rkeA rs Dept.LA 23234 sdark P cADv yr - Dp LA 23234
<br /> 6sao sin mA At.cnosazan36z [1 i //
<br /> 165m s.sun Pears sz.cersrm,cA BPAACA09au az6z Posadene,CA91185-3234 I32d4P{a&A,CA9l5
<br /> GENERATOR/JOBLOCATION BILLING INFORMATION GENtRATOR/iml LOCATIONDalC sL.F
<br /> -
<br /> BILLING INFORMATION
<br /> NAAfEGSH Q CHEC[(� fE .( -NAME �CASH�CHECK L] -
<br /> Vv r p rNsa_r�- 'i f-vY i-'s' vY�k.
<br /> ADDEES$ ADDRESS MMPA!'
<br /> DRESS ADDRLSS fER CODE No.
<br /> C-. L "�B- c 'Gla: f:.C-7AZv3 _ Cf(q'
<br /> C STATE Z� CO.QTY STATE ZIP CO. POR CL Y ST E CO.C,1TY STATE. ZIP �CO. -
<br /> 4 _ c" r
<br /> PHONE No. PHONE No, PROFILE NO. CUSTOMT N NO:- - . PHONE NO. PROCILE ND. C$NWRILRIA In No.
<br /> IP
<br /> ) `- iR
<br /> PRODUCT WASTE MANIFEST WASTE MANl1'IST%
<br /> CODE NUMBER Q�h-aTY UNITS PRICE AMOUNT PRODUCT - QUANTITY'>UNITS PIDCE AMO T,
<br /> _NT _ COOK, - .
<br /> Used oil,Nm-RCRAHmnNmu Lunda s CA22 -5 Gal. %fled 1 N RCRA HazaNwa I.ibm�armg CA2Y117_: Gat.'_ yf(4'
<br /> ore,liquid le.-al CAnI Gel. -
<br /> s
<br /> din W �i
<br /> Ga es,r4a,,, m'r°3m, k (jeJC.
<br /> Oil&IVa v,,Non-RCRA xazamws I-.Lgwa_CA223 Gal. OiIR}Yker,N'CRA HmaNmn 1YI,.tqW CA22S Gal
<br /> non xazaMow waw GA NwN¢Jmprawlu.
<br /> NuttSolitle and Sludges _ Gel. 1V Sol'Mc ind SiuGg „Gnl
<br /> wwn qrl Enai -'CS hon-° Eub
<br /> Prcsmm lvunerrso-am aeaim - Dar _Pre wmtarrsteaa,Ckaiia DAy;
<br /> Tmupwutip art. Tia poria IBg
<br /> Pvd Surcharge % I e ��-ud$IPclimgc� - •,q.:: f
<br /> 1, Giycol Bulk Sm. psifY Product -_- Gal. ` -',61ysd Hyo 3alSRK+rY Product - Cal
<br /> GIYxW BuI 151rcrifYPMuct, -___ - _ Gel. -- _ GIYroIH Cwe/Sjrccif'y Pmtls%t -
<br /> TEST: CWr D-r sad-VQ- I]Ciw DTe�n IWO Pmv []Feil CIa DReh " m •❑CIorOT Ii,IOW - Pu"f�, Fed
<br /> Retain smnpie#I — Tetai Char es Return slinple# oral Cha"es '
<br /> Re ailed 3 G 1 Re cored 4 .
<br /> Fild Smkglht*Ucttp t
<br /> Ocher:
<br /> QW OR4,,7,
<br /> TSD Cmuolidated Manifest DRIVE N C nsoiidated Ma fest ".D12XirNg,CCt{LTST' .r�
<br /> Evsgrten Orl ire. 1-I Eerp]xngLMs-Dora❑h em Oil,la Frccnv pTnrc in T' Ot -Evgrttn Od7 ❑Ew®dnfR! Dns❑B�Hgrtt��O1 Ni Fremo pn,gii,
<br /> 68805m hAvr t J Rwd 30B 39N Veknrive 68805mr0Asx+ Rma^3aB'- 4139N Ylentirs ,�.0 T
<br /> CAD98N74180 CAD%82\95618 Freseo,Ca 93>23 ❑Tnn:lnvnpropzrlyLbekd Nery�r4741560 Davn,t 95716 Fremo,C 37-:1 ❑T DDN Prp�ffly L¢UeIMr -
<br /> qq
<br /> CAD98088]418 CAU982d468J4 CAD98)A46862 ❑n U 1 k d
<br /> + CAD9808$]918-- CAD9824468J4 ' %CAD9g2�82 ❑A am Intion Sladgpe%'9elked - ..:; -
<br /> -❑Bvergre Hm.Sv<. E1ea�,028e-Sanh4a OH K p g I�iB ¢�v Sr tE i r§O ❑�1P RsYB_`1SaklD Cly_
<br /> -t6fiM"s s-n pee. ❑>$\votl3everwi.❑... _.. Don CM1.ttkM DOI..ri,slDru oA r ^�I17EO4s sin g �]gspw!Rill ,T QothwS KG chzg4sd aAd l7 FnerslFru pAnifr<w -
<br /> Carson,CA WJ 4 8G i¢CA 93459 C 'G9 $amaM"p C7t939jy -
<br /> CAD9R1696 AgA2446858 _ ❑C II d tie U.I. r nz CAD981d CAD9s2446g5g '�'D S Iled m `sae( CMtd t FlfttgrD A f ve
<br /> Genera <em0er mmnlms umNrsnedapm rem oMuce the smlume oreze Ge Rtwsertifi N bu bl dxG $=am rN ked
<br /> Source: Collection Station ❑GEvemment gnanmymmarmty or Ne narcmmra w.emmtie 1-1 aaewmM by Source CoiInCDon stattion �GotretRment aaar4 yR4w Ir riAylm3wdwq,�Aavk @JbmmCdaEmm�edbr
<br /> ❑Mauve ❑AgtieulmraI ❑Industrial gen rove ermmmrcnlr t¢aa,rable []Maine ❑Ap,133culRltal❑Industn,T� g mrmlpnbed,- nygra nk -
<br /> 1LHeii,carrry int 1 have read arta have tM mull nrlty m U1CHdD'-erpDfji IGRt-Lhgy kna n d d hdrilgm,
<br /> h'rM h bort slated eenenigr tv the[g ms pn n e revere i �Y.Ili d dNB� Iisied� f t Ib is[t� the rekeert- - _
<br /> sideormis Germ. -bid PlM1rs form's":..
<br /> IMPORTANT NOTICE REGARDING THE DISPOSITION OF YOUR OIL. IMPORTANT NO'PICRIIEGARDING THE bI PO$TTTt)NgFyQU OIL.
<br /> Per Caiffornia Neal[h arM Safety Code Section 25250.9,EWgreen hereby advises customer Naz cr tomes a sbipman of used ori may be Per('siR iq Heat149iLd SdYctg OOd!5,et4 253$BJ Ev*'--M by ad i@5s U>merN f L k rid,pins f usedpil 'aybe '
<br /> zansponed to a r dtty Nat is requ'ved to comply win federal xgaleimns appinable to mzgagemenl of vaed oil,but that a not required to anns'pmted fa 1},That coq—,P,td Ynpty aN feduml4xB 1 1 appl-ua¢Ic) aria eine 4of'sed II b l.N t pm.Yequrred W
<br /> nn IY wtm the mom rsngen[rcgmreme h appiicabte to hazardous waste management facilities Califomra E 'nes that handle oY pro cos used "'' ply N the sAmgbnt req , pill bl to h,42prP4 m3araAagpPmatf`ac bt S:C 1 f t f hl dmf,$WMkm pineals oxd
<br /> f required m meet lrh m*en rrWW menta,andsomeua Istat fediues thatP asst o' E meU Nose !aro ref d cetrir gee rtq cense&,7dvudd Jiab �}"',yt e.f 1fi shat P`spce Gd ilaigm i1n requ'uerytesjrs-
<br /> x'neseinclude more string,,%kak detecoontmM prevenow requirememu,engmanngceru6canoe-f ki g y, 5naacs mncw for TEr"sd lode mo stn' teand Ixt'pp sad prevent .M eek Cn&ria 8ittr&abggs hank tegmy amlfitkaa"al s f
<br /> tfnmlreleases ItmsendusMoilmoul-of scam hoboes that compyonlyR -1 agement sandarde aaingernsequi.menu.Tnia norilicedenh fmirdommhon patprsea anly. d 311t�se ngeni` menta:Tri f afar frmatxgd purpa2efbDly
<br /> Iver Signature Print Name Route# Date Generator's Sign re Print Name Date Driv Sgn t re Priri[Nan3e Route P Dat Gen rat6r"s SignaYue Pc !Name" Dat -
<br /> WadeComfusannl Gaw.rxek Ave M..Cem_rorwr D n.e'Gn ator's S......,mre n..n,..Print N-._.n__.. wane n..dv+e....6.e.r..,..: n....,r.�, rv..r.h*r•..:w
<br />
|