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1010812010 10:02 <br />f A>n P.0131045 <br />WORK ORDER/SERVICE AGREEMENT <br />Evergreen Envirommental Services <br />dediruted to the, prate -4 -tion u. f rile env1ponwitr <br />To Schedule a pickup, call Send paytrtent to. - <br />800 -596-9455 <br />o:800-596-9455 Evergreen Gil. Inc, <br />0880 Smith Ave.. Newark, CA EPA* CA®882413262 P.O. BOX 30517 <br />18640 S. Ban Pedro St., Carson, CA EPA# CAOM413208 LoS Angeles. CA 90030-0517 <br />Used ail, Nan-RCRA Ifar us Lubricating I 422 <br />Waste. liquid lndaarrial A221 <br />I.1mS AUW4Ai W Aaademo. M-4pll'a ttHr-M&Wp <br />W"W LbA id _- . 4.134 <br />Oil & Wamr, Nrrn-RCRA Haz rdtnrs waste Uqui <br />Waste Solids and Slade <br />Wash WE <br />Drained Used 011 Filter* <br />Nee•RCRA Hazardom Wane olds (aily debris) <br />Empty Drunt% <br />Non Haze W <br />Glycol t3ulkRM <br />Glycol su Cone. <br />Sales Order # <br />Date: Y+ — <br />STATE ZIP CO. <br />0 <br />go <br />`rte <br />M1 <br />ON <br />k <br />ON <br />fc <br />M1 <br />0 <br />� t <br />M w <br />Imo} <br />CUSTOMER EPA ID NO. <br />0 <br />AMOUNT <br />TESTZ Clor D Tech ppm ® Cl- n TO I (l[H) Peas [„ i Pail ® Halogen DgtecipNFlattx Test ❑ Pa C] Fail <br />Field Service work Dekeriptit , ' Tolal Charge` <br />other.I <br />-- <br />Other <br />Vad�aum S et Time ` <br />th:r of On Site Off Sitc Of Load Start Off, IA*d End Return in Yard <br />-Fsyv i <br />L['f 'Consolidated Manifest <br />Jiver en Oil, Inc,11 <br />68[0 Smith Ave. <br />P Teen Env. Svc. (�j Hverg fta Env. Svc. A3S filter <br />RUNG El *4139 N. Vslentine � <br />Newark CA 9d5bq ii <br />CADW9974IA i <br />15131 Caul{ Ave, <br />Davis, CA 95$16 Fresno CA 937?2 ) CA 91744 <br />1097432 <br />CADY8244697A CAD4�24d6M2 CA <br />®Jflverp n Env. S <br />ltag4 S, Satz P 1:1 <br />Bveryreen Env. Svc. CPR CPR r, Oftenleal' fate. Nw. <br />745 A West Senohtvm 944 E. Slaa�t ❑ �1 <br />) <br />Carxun. CA 90 b <br />CA09S1 <br />Ave. 33210 Wesiern "74 Tuyan Orcle <br />Salts Muria, CA 9104 Las An��ea. CA 91101 t Union Pity, CA v4587 Vulley 8prr x, CA 9d t�Z <br />CAD98244Giti8 <br />CALatllit 1f142J G 1507 CA[ l)tW2Yi 1 <br />SOUiYC: C011eCti <br />StatiOri GovernmentGenarator <br />cartirwi , that it ha -4 exudeliahed a prusram to redw,ro iWt volurrn or <br />quantity a toxicity or the haard®r.a tvame to the delimv, determined by <br />® Marine <br />Q A riCultural Industrial <br />gonemwr to tx eclintuttieuliy pna.Krutble, <br />t haeixl certify that I have read and have the authnft to <br />��$$AIII sampleside <br />bind the a" ttg_te_d_ venerator to the term on t_h_e-rsvet <br />of this farm. , <br />RTANT NOTICE REGARDING THE DISPOSITION OF YOUR 011. <br />Per California Health and H fety Code SeOlOn 252St1.9, Evergreen hereby advise% ous�tornor that curtumar'S Shipirtemr of used oil may ht: <br />trunxpuned to a facility that is requined to comply with federal reggulations applicable to management of t(,cJ oil. but that is not required to <br />the requirements to hiLv. maaazta neat facilities. Cidifurnia facilities that handle <br />pplywith more strings <br />Applicable sus waste en• provao ,i. used <br />oil arc required to meet thoswc <br />'rheic <br />ore stringent requirements, and some out-of-state racilitiee khat pommsa used nil also meet those requirenvnt*. <br />include more steinggent 1 <br />wk, deme ion and prevention requirements. engineering certil`ivatimi% of tank integrity. and financial a isurancea for <br />aI t. rr and accidental rolrures <br />It is luwfuI to tend used oil io out -of -stmt facilities that comply cutly with federal used oil management .rtandardn <br />at these ov)rc sninbent requirements. <br />This notification is for int'urmAtion purptxes Only. <br />$ �e <br />O�A!..•n <br />iteAr �'i7nseteernn Tint Name Rmet�! tlntw .a.» oe• a „aw D...ne P.T.. <br />