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WORK ORDER/SERVICE AGREEAMNT <br /> Evergreen Environmental Services A� <br /> dedicated ro the protection of the environment _ N2. 255768 <br /> To schedule a pickup, call Send payment to: Sales"Oider# • ", r�,.. <br /> 800-9.72-5284 Evergreen Oil,1ne. A je <br /> 6860 Smith Ave.,Newark CA EPA#CAD992413262 P,O. BOJ{ 678252 <br /> 165a0 S.San Pedro St.,Carson,CA EPA#CADS82413262 Dallas,TX 75267-8252 <br /> GENERATORIJOB LOCATION." BILLING, INFORMATION <br /> N .. . <br /> CASH❑CHECK❑ <br /> ADDRESS,, _ # <br /> ADDRESS FU Tott>ER o}iriyo. <br /> CITY , , STATE G E0. CM, CO. #' 444 <br /> PHONE No PHONE N0: PROFILE NO. <br /> WASTE MANIFEST <br /> PRODUCT CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 . <br /> Waste,Liquid Industrial CA221 Gel. <br /> „w vmnWve AaWene,Nm-RCA H•zervaw CA134 ' <br /> R Wm rsmawi0k t;4rod <br /> NAS.NA Tf.qayay�.�] <br /> t 9 mmmV MG aV tWt�r'4a1 Gal. <br /> �' . ai -RGRlwklezardbu R.Flste " 'd 2'x1 Gal. <br /> Waste$olidsaad S es, ri r <br /> Waah oat•- :. ,. <br /> Drained Used 011 Filrors <br /> Drum <br /> N(rrRCRA Hazardous Waste Solids(oily debris) CA223 , Drum <br /> Empty Drums ', . Drum <br /> Transportation ... + I;s. r. <br /> Non HAWdous Water Gal. <br /> TEST:❑Clot Wrech 4o00—ppm ❑Clor D Tcch 1000gPaas❑Fail ❑ Halogen Detectot/Flame Tam ❑Pass ❑Pati <br /> Field Service Work Description: Total Coat es <br /> Otter: <br /> Other: <br /> p .•� <br /> Vacuum Services Time „r 1'✓ 'v..+' <br /> Out of Yard Cm Sia Off Site—Off Load Start OH Load Hnd Rehim to Yard <br /> TSDF C=901idated MaWeSt _ } <br /> ❑ 8vergreeq Oil.Inc. ❑ Eve teen BLv.Svo.• Ev etn Env.Svc. ATS Piller ryry }l dry;o r, . ryr,,• 1 <br /> 6880 Smith Ave. Road 30B ❑ ❑ A{� rP„�_; ] - •" i <br /> Ores o, Valentine 15131 Clark Ave. <br /> Newark,CA 94560 Davis, 24 95926 Fresno,CA 93711 Indusaayy,CA 0]74 a. Y <br /> ('AD980887418 CA11982446874 CAA982446882 CA0000097432 P . <br /> Evergreen 6av,Svc, �l Evergieen Env. Svc. ❑ CFR ❑ CFR �rr�ryleef'Enf <br /> 16604 5'San <br /> Pedro LJ 745 A West Beneravia 944 E.Slauson Ave. 33210 Western 3474 Toyon Cirole <br /> Carson.CA 90746 Santa Maria.CA 93454 las Anggeles.CA 90011 Union pry CA 94587 Vail y Springs,CA 95352 <br /> CAD98169642o CAD992446858 CAL000110021 CAL00009i507 CALL 00214411 <br /> Source: ❑Collection Station ❑GovernmentOmeie or ardfies that it has eamblkhed a program to radUA tBe volnfne or <br /> geZity&toxicity of the hazardous waste to the degree determined by <br /> El Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> 1L8t81H S2Dl bind the above fisted ¢enerator to the terms on the reverse <br /> . side of this form. <br /> 47 <br /> Driver 9lgnat ;'A: Rint Name Route# Date Generator's Signature Rent Name Date <br /> L 'd _ 1096' ON Wdltl 0001 '91 • unr <br />