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Sep 04 09 03: 16p Lindsay Schwager 2099523389 p . 4 <br /> `-' WORK 0RDE1w6ERVICE AGREEMENT <br /> � �iJ� � <br /> Evergreen Environmental Services � <br /> dMicared to fire pmrecrion q(the environment <br /> To schedule a pickup, call Sand Payment 10: Sales Order # fel`►�f <br /> 800-596-9455 Evergreen Oil, Inc. <br /> 6880 Smith Ave.,Newark.CA EPA*CAD962613262 <br /> P.O. BOX 30517 <br /> 16660 S.San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles. CA 90030-0517 <br /> Date <br /> GENERATOR/JOB LOCATION BILLING INFORMATION CASH❑CHECK❑ <br /> \ME A f NAME # <br /> ADDRESS o <br /> ADDRESS C R CODE NO. <br /> STATE ...IP CO. CITY STATE Z1P CO. # <br /> G <br /> PHONE NO. PROFILE <br /> H E 'O. NO. CU �31ER EPA ID N� t <br /> Zy '8 <br /> WASTE h1ANIFEST QUANTITY UNITS PRICE AMOUNT <br /> PRODUCT CODE NUMBER <br /> Gal. <br /> (:sed oil,Non-RCRA H+¢ankws Lubricating CA22 Gat <br /> Waste,Liquid Industrial CA221 GuI. <br /> Uaa A,..-I"nmifnxn.WOMCan Il+rvanluu: CA 134 <br /> K.nm I.i,++N CA221 Gtll. <br /> I,Q wan IMnM,+:Pte LiyuiJ.NA.ti.a'NA FMImF of <br /> me w nm nnn,n+,nwca.+a,eni..+. Gal. <br /> Oil&Water,Non-RCRA Hauxdons Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Each <br /> Wash Out Drum <br /> Drained Usal Oil Fillers <br /> Non•RCRA Havardotn Waste Solids(oily debris) CA223 Drum <br /> F:n.pty Drums Hes. <br /> Transr,ottatitm Gal. <br /> Von Ilvmdous W,ter Gal. <br /> Glycol But 5W.O Gal. <br /> Glycol But Cum:. <br /> TEST: t'In D Tceh Prior Clor D Tech 1(X0 Pass❑Fail C3 Halogen Dca�um/P41me Test ❑ Pass ❑Fail <br /> ULal Cha CS <br /> Field Scrvicc Work DeseriPlion: <br /> Other: <br /> Ocher. <br /> Vacuum: rvices Time <br /> Out'itand On Site <br /> OJT Sitc__Orf Lmd Stun on Load Ertl Rctum to Yard <br /> Consolidated Manifest <br /> ,[,S <br /> Evcrgrecn Oil.Ine. Evcrgrtron Gnv.Svc. El 41 iEveY N�V Ivrotinun Ent. c 1513JS 111C'lark Ave. <br /> 6RI%I Smith Ave. ❑ Rond 311R pnsnu•CA 93722 Industry.CA 91745 <br /> Newark,CA 44%) Davis.CA 95616 C..AD9%2446%N2 CALXW097432 <br /> CAD9%0%%741% CAt )%2446%71 Grceenlear Env.Svc. <br /> Ecaxglern Env., V. Evergreen Env.Svc. ('FI2 <br /> (hR ❑ '7474 Toyon Circle <br /> ❑ 16(#14 S.San P ro 745 A West BcticrMia 944 E.Slaason Ave. 33210 Union Cit,C Valley 'piing 1 <br /> Cann.CA` lU Santa Maria,CA 97454 CALIX Ili <br /> 9[011 CAL( 17 945%7 CAU Springs.CA 95352 <br /> CAUr)%1 _II CAD982446858 GCAL( cenil ics that it has established a Program to reduce the volume or <br /> Source: Collection Station C1 Government 4` ort to1va nnoni Elf callyrPnutirnhtc us ate to the degu determined by <br /> Marine Q Agricultural ❑ Industrial I hereby certify that I have read and have the authority to <br /> bind the above ItSted venerator to the terms un the reverie <br /> Retain sample # <br /> 3j ("' � side of tb'v6 corm. <br /> ID9POR'fANT'NO'fICF, RRGARD[NG THE DISYOSlT[ON OF Y"OL'R O[L. <br /> Per Catilornia Health at nd Sandyl rcude Seunirly 2`?hlfcJeralcregulailons'3pl>filcable to nlanaguotcnt ol'tuced nilhttwt thatl�ls not required u <br /> transported to a facility that q <br /> comply with the more stringum rcyuin:nnnts aPPuruhknt l.li d.dmc un�oF'statc facilit sallmtapm�ss to ed loilctdsoemuatthose andnequiaor rancial umes used <br /> s fill' <br /> tit arc required to most thuya more sulugent aye y, <br /> These includesmore strin <br /> dread rolalsu.vc 1 drlawlul hnsa. cusalloil rhllUiut�ol„talc Iacilitics lhm comply onity with fri;dcndtused gill Immugcment�standurds <br /> c m and <br /> •n not these Inure stringent rcyuin:ntrnls. This mnilie;nion is for inh.rotmion pnrpnscc only. <br /> L <br /> .. o_:... nt.....� Renck # Date <br /> tcllerator's Sit/nalurC <br /> Print Name Date <br />