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2011-Feb-11 02:10 PM DSW AG 209-z':-836' 17142 <br /> WORK ORbr R/SJERVTCV AGREEMENT <br /> Evergree Environmental Services:44, N-0385686 <br /> rte IC11 tl 10 rlie 1►rorcrllna of 1114,wilownineol <br /> To Soho ule a pickup, call Send pur'ment to: Sales Order# P� <br /> 800 5969455 Evergreen Oil, Inc, <br /> 6680 Smith Av®.,Newark,CA PAR CA0062413262 P.O. BOX 30517 <br /> tasdo 3.San Wedro St..Carson,UA F13A#CA0982413262 Lor Angele:N, CA 90030-0517 Date:Z <br /> GF.NERATOR/JOIi LOC TION BILLING INFORMATION <br /> NAi<IGW G N tINIE CASH CHECK <br /> AD gF.54L)C <br /> ) G ► h t\ !1 t l 0 f r3 n �ot)RtrS'. CUSTOMER CODIZ No. <br /> et-lUiNI, NO. PROFILE NO.' CUSTONIFR�[D (, <br /> PRODUCT WASTE MANiMST QUANTITS' UNITS PRiCE AM1IAUNT <br /> CODs: NUMBER <br /> Ured on.Non-RCIZA i ta7atthrH,r Luiulcating CA221 1 a( (F 2p Gal, ( , <br /> 1Vncta.Li uidindustrial CA221 Gel, <br /> INA Alam mkv Anlineere,N,m-NCRA Ham nu. CA 134 <br /> HV way le Comnw[ibh l.iyvGl.N.A S.vn CAM <br /> Kll 4f ran lh Anda .[ t--WIN1a'_ 1 GO. <br /> Oil&Wntcr,Nun•RCRA 14-ardou,1 Warta Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> wuch Out Each <br /> Druinctl Used Oil rltcns Drum <br /> Non-RCRA H:uan)nua Wnatc Sollda(oily ticbds) CA223 Drum <br /> Empty Drums Drum <br /> Transportation <br /> Hrs. <br /> Non Ha?.ardnus Water Sat, <br /> Glycol Bulk 50/50 Gal <br /> Glycin Bulk Conc. Gal <br /> TGST:tZCIor D Tcch 411 pat Q Mr D'fech IOi 'Rpasv❑Fail ❑ Halogen DetoctoNPlame Test ❑Pass ❑Fail '?,z> ZZ) <br /> Fuld Service Work Dcxeriptinn: Tu[al C'ittu'rt <br /> 01114,1: <br /> Vacuum <br /> � <br /> nm Scrvitcs Tlmc <br /> Out er Yard Da Site Orf Size Orr Load Stan Orr Laud End Return to Yard <br /> TSDF Consolidated Manifest <br /> t'- t „rrn I:m•,sxv, ❑ F.rtrpoell Env.Svc. E A1S Fillcr ❑ -- <br /> 6)(Mi.said(Aw. L,J kn�7011 4139 N.Valentinc LJ 15131 Cinrk Ave. T <br /> Newark,CA 3.1560 Dav44c,CA 95616 Fresno,CA 93722 Industrryy CA 91745 <br /> CAD9RniM7419 CAt3982a46874 CAD982d46SH2 CA )97431 <br /> liversn'cn Env.Svc. 1�1 Evcrgrecn Env,Svc. r7 CFR CFR Grccldcal'Flit-,Svv. <br /> u 166tH S.Sun Pedro 745 A west 13eHenwia 444 H.Slauuun Ave. 33210 Westarn 3474 Toyon Cirelc <br /> CnrKon.CA 40746 Sani[ tyltirla.CA 93454 Luc AngalcK,CA 90011 Union City.CA 94537 Valley Songs.CA 95,332 <br /> C'AD9816')ir1211 CAI)82446858 CAL000110021 CAL000091507 CALI)(10214.1tt <br /> Source' -Collection $t4,tion ❑Government Generuor cenifcs that It has eslahlished a paVram to reduce the volume or <br /> quantity St roXicily or the haratrdnus(code to 111v dcltrec deternitncd by <br /> Murine ❑ Agricultural C3Industrial gcnernor to be economically prrcticable. <br /> I hereby certify that I have read and have the authority to <br /> Retain sample # C_ I hind the nbove listed generator to the terms nn the reverse <br /> side of this form. <br /> iMPTAINT NOTICE REGARDING THE DISPOSITION OF YOUR OIL„ <br /> Per California HCnfth :laid Surety itode Section 25250.9, Evergreen hereby advises customer that customer's shipment at'used nil may be <br /> transported to n Facility that is rcquirgr�d to comply with federal regulations applicable to manapment of used oil. hitt that is not required to <br /> Comply wills the more mri❑acot rrqulwilents applicable to huwardous waste managemcnt,facilltles.California facilities that ilandle or process used <br /> nil are required to meet Ihose store s Hnggent requirements,and some out-of-state facilities that process used oil also meet those requiremernc, <br /> These include marc stringent leak detection and prevention r0quiremenLS, engineednb certiFIC2 0115 of tank inte;rity,and financial assurdaces for <br /> clnsure and accidental retenseK, it is lawful to send used oil to out-of-state fuellities that comply only With federal used oil management standards <br /> anti not t mote,fringe qulre ents.This notifcntion is for informntion purposes only. <br /> I <br />