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2011-Feb-11 02 10 PM DSW AG 209-3':-SS6-, 13i42
<br /> WORK ORDER./, 'RVICE AGREEMENT
<br /> Evergreen E vironmental Services N° 4 3 2 0 21
<br /> rlrrlir'un•J nr rlr•�+Pnrrrrinrr .r/!hr r'nrA'rurnfrrrr
<br /> To schedule a Ickup, call Send paynivnl to: Sales Order #
<br /> 800-59 -9455 Fvergrecn Oil, Inc.
<br /> 6880 Smith Ave„Nowark.CA EPA#C 982413282 RO, BOX 30517
<br /> 18340 9,San Pedro SI„Carson,CA E A#CA0982413262 Los Angeles. CA 90030-0517 Date; 27ia 7
<br /> GENF.RATOR/JOn LOC:ATIO _ BILLING INFORMATION
<br /> IE
<br /> NAME I CASH
<br /> clacK Q
<br /> ADDRESS a ADD ,'S CLI CODE.NO.
<br /> (-ITV _ •tiTA"i'I. ZIP CIO. CITY --` SPATE Z11+ CO. PO M
<br /> P ( 'YF NU, G PHONE NC), PROFILE NO. C'U TO!41L:R FI'A 1D NO.
<br /> 7z jao
<br /> —�---- WASTEAN1FF,ST Y
<br /> PRODUC'7� WASTE(�O(T NUMBER QUANTITY UNITS PRICE: AMOUNT
<br /> Used nil, Nun ltC'kA IhlrarJ,lu. Luh Cjmig CA21C;af.
<br /> waste.Liquid IuJt U-i;d CA221 i Gal— -
<br /> li•pl ANunNa•,\nlilnva.K.mkr'N:1 Ilv„rJnn' (,A 134 Gal. --.---
<br /> NfJ 'I
<br /> rat w irrd.,.vr 4 vn. __ FuilrlSAB Gal.
<br /> Oil R Witter,Non-RCRA Rwin ou.Waalc .iquiJ C'A!?1 (40,
<br /> Waste Solid,and Sludp".,-- - _I _ Gal. - -- - - --
<br /> Wash 9I11 Each
<br /> Orainvd tfwd Oil Filter. - ------ Drum --- - -
<br /> N.,u-RCRA Hunanloue Wur•le Solid;fully dt tri.,) C'A'_2� Drum -�
<br /> Empty Drunts Dinum —�
<br /> Transrctrtatioll Firs.
<br /> Nun HavArdou Gal.
<br /> Glycol Bulk 50/50 md.
<br /> Glycol Bu Clint:. Gal. _
<br /> TNSTO Otir D Tech 4w q -ppm Ow D Tech 1000 Puss Q Rdl Halogen Detvcwr111umc cxl ❑ Fa , ❑ Fail
<br /> Field Svrvicc Work Dvxcriptiunf rw;tl Churt_c i
<br /> Other:
<br /> Otter:
<br /> V10.'tl mi S rvlccx Vitae
<br /> Out itl' and Ott She Or Elle 011'Land Sturt 011[-,,:,dEnd e(um it,Y;ird
<br /> Yk
<br /> JF."'�rcen
<br /> F Consolidated Manifest
<br /> OII,int. 1, , xn :nv.tivc. n kivcr•rcen Env.Svc. AJ5 Fihrr
<br /> HNlSmith Ave. o1 3014 L� 7129 N.V;duntinv 11 IS 131 Clark Ave.
<br /> Ncwark.CA 44560 Davis.CA )5616 Fresno.CA 93722 Industry.CA 91745
<br /> CAD980487414 CAD9,421d X74 C'AI)9X^4dh)(92 C,1f]fll)HAM132
<br /> I'-I t':vorgrccn F,nv.5' ❑ I.tt'rgrerrt mv.tine, n CTR r� CFR r., Crrenletd'f!m. Svc,
<br /> f__J Ihftlt 5.tiau P m 771 A Wks IIPuvniviF4 L' 444 1.Slausun Are, L 13210 Weslem 3474'1ltvun C•irck:
<br /> call n.C•A 9 46 Suniu 4lur' .(•A 93454 Lits Anyy,•,aivs.CA 1)001 1 Union City.CA 44587 Valley S`prhlp'C'A 4515±
<br /> C'AD99164 _II CAD4t173d k5X C'A[,fll>O111H121 (rU t11H)1141 St17 CAlJ10021441 f
<br /> Cenennur certifies that it Ino esudtlishcd a prognim t.+M1110:the volume ar
<br /> S011rce: 2J Collection Studon :1 Government yu;lllNty&imicly of the hazardous whsle to file Jegnc detenninrd by
<br /> T Marine D Agrict`ltural I, Industrial genvraint to he economically praoic•ahle
<br /> r--- I hereby certify that I have refrrl and have the nulhnrih�—to
<br /> bind the above listed_&ger•ator to the ternm un the_r"I:r,;e
<br /> Retain sample #_17— side of this form.
<br /> IMPORT�NT NOTICE REGARDING THE DISPOSITION OF YOUR OIL.
<br /> Per Callrortila Health and Sarety Code , ectinn 252511.4, Evcrgrcan hereby advises customer that Custorner's ;hipment of used (til may IV
<br /> transported to a racility ilia( ix reyuitrd to Comply with 1'ederal rettulufion.x appllenhle ut fnunagelnem of user) nil. but that is not required to
<br /> comply with the more stringent rryuireme�pts applicable to hazardous waste munugement facilities. Califomia facilities than handle or Croix." used
<br /> oil 1 rc rce�uin d to meet those more striq mq retltlirenictits. and same OLIt•O]'-.rote faCilitiex that Process used oil also meet lhoxe ttyutrenlenr,.
<br /> TE include more stringent leak deteWhflm and prevention requirements, engineering certifictltions of tank itlteprity, and financial assurances for
<br /> c ist re zinc] aecidenfal relcases. It is lawful to xend used oil to nut-ol'-state racilitiex that cninply only with federal used nil management standards
<br /> nd lot these nu+rtr strinpeni requir'enlentsJ'rhi.x notification is for information purposes only.
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