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• RECE-N <br /> / ���g <br /> J WO�fK O SERVICE AGREEMENT <br /> E OF MER6ENCY SENRVICES 0 <br /> Evergreen Environmental Service N_ 252304 <br /> dedicated to the protection of the environment qq�� �p--���� <br /> To schedule a pickup, call Send payment to: Sales Order#2_ 2f 3= <br /> 800-972-5284 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 P.O. BOX 678252 J/�., <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Dallas,TX 75267-8252 Date:�7hl � <br /> GENERATOR/JOB LOCATION BILLING INFORMATION I v <br /> NA NAME CASH !Ta <br /> # <br /> D1ruyRESS ADDRESS CUSTOMER CODE NO. <br /> CITY STA ZIP CO. CITY STATE ZIP CO. PO# <br /> G� sr—rc;P6 <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> (o b ( 7 <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 ZZot� Gal. <br /> Waste,Liquid Industrial CA221 - Gal. <br /> Umi ttomouve Anuame.Nan-RCM H udoua CA134 Gal. <br /> Wa¢Ie Li uid <br /> RQ Was1,Combustible Liquid.N.O.S.NA CA221 Gal. <br /> 1993 III Oil conumi�uted w,m bolo uis !+W I/FW2 <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Drained Used Oil Filters Drum <br /> Non-RCRAHazard s Waste Solids(oily debris) CA223 Drum <br /> Empty Dru_ Drum <br /> Transponalio Hn. <br /> Non Hazar ous Water ""��77�� Gal. <br /> TEST: Clor D Tech 40urtitippm ❑Clm D Tech 1000 Pass❑Fail ❑ Halogen Detecton'F7ame Test ❑Pass ❑Fail �j x <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum ervices Time <br /> Out of and On Site Off Site Off Load Start Off Load End Return to Yard //10 <br /> TS F Consolidated Manifest <br /> Evergreen Oil,Inc. Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ AJS Filter <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine 15131 Clark Ave. <br /> Newark,CA 945 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980887418 CAD 2446874 CAD982446882 CAD000097432 <br /> Evergreen Env. vc. Evergreen Env.Svc. ❑ CFR 1:1CFR Greenleaf Env.Svc. <br /> 16604 S.San edm 745 A West Betteravia 944 E.Slauson Ave. 33210 Western 3474 Toyon Circle <br /> Carson,CA 746 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD98169 20 CAD982446858 CALAMI 10021 CALOM1507 CALOW214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Ld Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> L]Marine (] Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> bind the above listed generator to the terms on the reverse <br /> ain sample # .5,G side of this form. <br /> ��b Y <br /> D r Signature Print Name Route# Date Generator's Signature Print Name Date <br />