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2011-Feb-11 02:10 PM DSW AG 209-"9-8867 6/42
<br /> WORK U1tDEI�"iSERVICE AG�2E
<br /> Evergreen F-Ovironxmentai Services EMENT
<br /> 40. r, ��� „1� ,,,tr>,.<' /n N° 555202
<br /> To schedule plckup, 0911 Send pa%'mcvlt tr,:
<br /> 800-59 -9455 Sales Order# ------
<br /> 511141,
<br /> t+xx0 Ave„Newark.CA lilrAA t o >~'vergrnon Qh.Inc.
<br /> 16-140 S.Sun Pedro tit.•C'nrlun.CA 1 PA1/(AF)uN?413262 Dept.LA 23234
<br /> (;ENF-XATOR/ Ora Puxadonu,CA 91 185-3234
<br /> J LUCATIq$V BILLING INFORMATION Date;
<br /> Mr:
<br /> NAME
<br /> AD RRSS ` CASH❑CHECK❑
<br /> ADDRESS #
<br /> TOMER('OD N0,
<br /> 'ITY r S ATP: !IP CO. CITY
<br /> ST'ATLr 7,IP
<br /> PHO NO, d
<br /> t PHONE.N0, CO. PO A'
<br /> PROFiLE NO.
<br /> CUS OMltR EPA IU N .
<br /> PRODUCT WASTE. MANIFRST
<br /> CODE, NUMBER QUANTITY UNITS PRiCF, AMOUNT
<br /> UNcd oft,Nan RA Luhrlcuting CA221
<br /> Waxte.Liquid Q Ottl,
<br /> 9 lndurrial CA221
<br /> LItM AuI-milhAnllhtyrn,Non HPRA Ilaan6,,,, Gal.
<br /> 'A 1r1� a CA134
<br /> kQ wanrr(1,mhwtiLle tJpuiJ.N.r7s.NA Gnl,
<br /> 19931n morn Jwlm em CAj71
<br /> Off Water,Non- CRA Harardoux%xic liquid ICA223 Gal.
<br /> Non Rayardoue WJtcr Cal.
<br /> Waxto Soil&and Sludges Oul.
<br /> Wash Out Gal.
<br /> Pressure Washer/Stealll Cleaner Each
<br /> Day
<br /> Trahsp rictinn
<br /> Fuel Surcharge I-IIs'
<br /> Glycol Rulk 50 /Spuoiry Product %
<br /> Glycol Bill' oncJSpcciry Product
<br /> Gal.
<br /> TEST: Clor D Tech 4000��ppm ❑Clor D Tech I ono PaxA
<br /> ' E]Fail
<br /> gc !imd ! Total Char�rx
<br /> i2v
<br /> Field Service Work nexcription:
<br /> Other: -
<br /> Other:
<br /> Ts
<br /> Consolidlttc Manifest !)RiVhlt CH
<br /> hvcrpreen 011,Inc. I:vcrym:n Oil.11 C.-Davis I?verylec Uit.Inc,-tln xno _ --
<br /> 6690 Smlth Ave, ltnutl 311ft ❑4139 N,velcnlina I; 't'irin ht.._„'I alis(hill
<br /> Newark.CA 94361) Davie,CA 95(I(1 41, n CA 93723 r7 'Imik/))rain Propvrlt�Labeled „
<br /> CAD9811RR7aIR CAD982446H 4 CAD9N2446882
<br /> Ac•rumillalirit,,SI;n1 h;th'\1arl,pd
<br /> ❑ Evelpreen Env,Sve, n From-•nalh.-imp16604 S [', l lun.c Kedpinp t':ulk/))rata('I�:u�
<br /> amn..5:m Ped U 7driA Wcsl Bclfe9345 t.r 11111vr,Scnices('lurkcrl: I.1 fill. I'I I iltcr./I)1'tlnl�, [7 \ntlfrv�n
<br /> Cencon CA 907 Santa Marta,Cit 9345a
<br /> CAU9R16964 CAD98244681 [2 t'allyd in rgher.,r\i nyc�lrit�Oiler ' [ihrrJll:unl., AnNticr�c
<br /> Source; Generator cerdnrA that It has e-itablished u pmglntn to reduce)hums or
<br /> -
<br /> Collection Station 4]Government quantlty&toxicity or the hazardous waste to the degree dotenninctl by
<br /> 0 Moline ❑ /� 11Cltitll fl] ❑ ]pduStTlal generator m be economically practicable.
<br /> i herehv certlt�that t hays rear[ and ti �► nd tv to
<br /> bind the tehOVe listed non t r
<br /> fiJAIL this form e
<br /> IMPORTANT,I NOTICE REGARDING THE WSPOSITION OF YOUR OIL
<br /> Per California Health and Safety Code Section 25250,9,Evergreen herby ndvixex customer that CUstomor'9 xllipnlent of tlxcd tlii tasty he
<br /> transported to a I'acility that ix rcyuirad to cont�ly with federal rugulatlonK uPPlicuble tel managctttenl of used ail.but that is ltul requires to
<br /> Comply with the nl0re stringcm requirements ilpplicable Io hazardous waste management facilities.California facilities that handle or rimmmN axed
<br /> (til ore required to meet those more,r'lrin�emt requirements,and x01110 OLIt-of-9lalC faCilitiex[hit[proee%14 t1Hcd oil tilx(1 111col those requirements.
<br /> TI include mitre stringent ICA detection and prevention rcquirerlicnts,engineering certifications of tank lntegrily,and financial&S,5UranCCS for
<br /> clc and accidental r cases, !t is lawful tosend used oil to(tut-of-state facilities that comply only with federal usedtail manugemcnt standards
<br /> t there more stringent 'quircmeniN.Thi notifieution is far information purposes o�ues Signature Print Name Route# Date nera r s Si nature
<br /> g print Name Ditto
<br />
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