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Sep 04 09 03: 18p Lindsay Schwager_ 2099523389 P.6 <br /> WORK ORDEI.AERVICE AGREEMENT <br /> AgdEvergreen Environmental Services <br /> N° 474190 <br /> drdicurrd rn rdr PrvrrCclinn ql'fhe rnrirnnnuml <br /> Send payment to: Sales Order # <br /> To schedule a pickup, call P Y <br /> 800-596-9455 Evergreen Oil, Inc. <br /> 6660 Smith Ave.,Newark,CA EPAp CA09824/3262 <br /> P.O. BOX 30517 Date: — y 11`b <br /> 16540 S.San PLWro St.,Carson,CA EPAM CAD962473262 l.ns An�dC%,CA 9n030-0517 <br /> 1111.1.ING INFORMATION CASH Q CHECK <br /> GENERATOR/JOII LOCATION NAME. <br /> MKn # <br /> 1^ ADDRESS CUS F CODE N0. <br /> A] A r <br /> ,N STATF, %IP CO. # <br /> CITY STATE ZIP CO. CITY <br /> Pit( NO. PROFILE NO. CUSTOFng[iPA ID NO. r <br /> PHONE NO C t <br /> WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> PRODUCT CODE. NUMBER <br /> Gal. <br /> UKxI oil,Non-RCILA Hazardous ing Gv2'2III Gal. - <br /> wa,le. Liquid Industrial CA221 Gal. <br /> 1'•:a n,m+vwss niaomr.,•.n.,,.xrxn x+r,,.v+• CA133 <br /> l.n„I Gal. <br /> Nihu'I ji W1 NfIS N.\ NnNiML _ <br /> 1'1`11 III roil anonninat'•t of, v. tial. <br /> Oil&Water.Non-RCRA.11=111ows Wage Liquid 0.4221 Gal. <br /> Ways Solids and Stud911 Each <br /> Wash Out Drum <br /> IMIims1 Cowl Oil Film, Drum <br /> Nor-RCILA Hazankms Waste Solids(nily debris) CA223 Ilium <br /> Hmpty Dnmis - Ion. _ <br /> Tramlmnatkw - Gal. <br /> Nun H:vankxls woffer <br /> Glycol Bulk 50150 <br /> Glycol BillCone. ' <br /> TEST: Ckx D Tcch 11X4) IPIII Q Cir"'Tech IMI Pass❑lilil ❑ Italog�+l Relator/Y•lamc'I'tsI Q P a Fail TOlal k haroes <br /> FteIJ Service Work thscrfptiow <br /> Omer: <br /> Mir: <br /> vacumll •rvicex Timc Rctnnt l yard <br /> UIY Site - )II Load Slarl OYI'IexlJ GnJ_-- <br /> Out ul and On Site _ _-- <br /> Consolidated Manifest <br /> T. F <br /> Ever rcell Oil.Inn Fvergrtrn Enc. Svc rr--�� 411live1grera alenl Svc. ❑ AJS 15131ClarkAve. ❑—_ <br /> (,491)Smith Me. ❑ Road ,MB IJ 413)N. A 9372 <br /> t Eocene,CA 9}722 Industry,CA 91715 -------- <br /> Newark.0.49450) Davis.CA 9%16 C,11W%+_446k C'ADXXXXN71"1^- <br /> CAI)9%1%%741% CADS%-Loo%74 <br /> C.I;R r1I 34"41 myon ICi Boat. <br /> ❑ E•vergmcn 1{nv.S ❑ i'.vrrv�flcn l':ay.Svc. ❑C6R ❑ 39110 Western u 34;4'fay rn Circle <br /> 10414 S.San P nt 745 A West Brll ravin 9474 8. Slausnn Ave. ('ALIX)n-1141 I <br /> Calwnt. A 9 '16 Santa <br /> uta M?win CA AR%5% (13i5i COAL IIXII IIfX)21^(xX)I I C N.IIIXXIY)I5n7')3587 Valley 5�)rings.tir In)10 nxIUCe the a'dtlme Of <br /> GAD 1%1(PM Il ..- Ge;iennnr colitic•tbut i1 has cualdished a pn;. <br /> yuanllly& loxicht.lot the ha%ardMh waste It,the degree determined by <br /> Source ollection Station ❑Government knera0r In he economically pl:mticahle. <br /> Marin U Agricultural ❑ Industrial1 heroht ccrlifv thud l here read end thene otharit to <br /> bad the above listed -encrat0r to the terms on_thc rewme <br /> y sidOUR 011•• <br /> e of the'ftlrm. <br /> Retain sample #–s s-.– k�— <br /> IMPORTANT NOTIC'.F. REGARDING THE DtSPOs1'I'ION OF Y (lit may be <br /> Per California Hea11h and Saretr CodeSection25250.9li , micrcguluih n.'Iapplili•:Iblo 11)1 manak'Lnx`mer that lof used oilstomer !h n% t thut�islnnt1rctIt" rJ I <br /> transposed to a I'acilily that is rnryir«I h Comply <br /> s •Ind solus,cul-oY-slide Ihcililics Thal pukes%used nil nlwl muco IhaM i:tl ylssumn0cs lir <br /> comply N•ith IIIc store string@at quired Io 0pWille a)Ilatregus waste nl:ulugs,nlcnt Yas,ililius. California rneilitics Ih:u handle ar pnxcss x <br /> oil ae required to u'eel 11105(: nude stringaL rcyuircnunt... <br /> 'Thee include score slrin e:ni le IL IS�11Ntl 11l mllselld 115CJ`Od [l1 p1111 Ila 31alC II:II'Ihlll'.<I I181eel <br /> 1'OI I pIy IonlyY Willi leder 115eland <br /> Ddlllllillla,_Cllleill 51:II1Jaf(is <br /> dna •and acladoola <br /> and (t these: nwr0 Ntringent requirements.'Phis nolil'icalilnl is lir infonnaliun purposes <br /> only. <br /> _ ��-----��• � �\ ',J -ill l <br /> IZOIItC # Daleencfttol's . IM1IIItI rC <br /> 'ver Cic na111rC fllll <br /> ante _. ._._.. — <br />