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' WORK ORDEi ,ERVICE AGREEMENT <br /> Evergreen Environmental Services <br /> dedicated to the protection of lite environment NO 231623 <br /> To schedule a pickup, call Send payment to: Sales Order# <br /> 800-972-5284 Evergreen Oil, Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 P.O. BOX 678252 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Dallas,TX 75267-8252 Date:—11y/o S <br /> GENERATORUJOB LOCATION BILLING INFORMATION <br /> N ME ` NAME CASH CK <br /> �j # <br /> "ADDRESS� ADDRESS CU u�C D NO. <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA Ill NO. <br /> 44 <br /> ( ) <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 fo Gal. /e> <br /> ¢ <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Automotive Anti ..em,Non-RCRA Hazardous CA 134 Gal. I <br /> Waste Liquid <br /> RQ Waste Combustib Liquid.N.O.S.NA CA221 Gaal. <br /> 1993 111 Oil contamir led with halo ens MI/FW2 <br /> Oil&Water,N -RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each j <br /> Drained Used Oil Filters Drum 11 <br /> 1 <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum <br /> Empty Drums Drum <br /> Transportatio Hrs. l <br /> l_ <br /> Non Hazar us Water Gal. <br /> P <br /> TEST:12rClor D Tech 4000,Zmi_ppm ❑Clor D Tech 1000 Pass❑Fail ❑ Halogen Detector/Flame Test ❑Pass ❑ Fail <br /> Field Service Work Description: Total Charges <br /> Other: ; <br /> Other: <br /> Vacuum jervices Time Q <br /> Out of and On Site Off Site Off Load Start Off Load End Return to Yard LJ��. bio <br /> i <br /> TS Consolidated Manifest <br /> Evergreen Oil,Inc. ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ AJS Filter ❑ w <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 _ <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen Env.14c. ❑ Evergreen Env.Svc. ❑ CFR ❑ CFR ❑ Greenleaf Env.Svc. <br /> 16604 S.Sy9p <br /> dro 745 A West Betteravia 944 E.Slauson Ave. 33210 Western 3474 Toyon Circle <br /> Carson,CA6Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD98169 CAD982446858 CALOOO110021 CAL000091507 CAL000214411 j <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Uf Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by — <br /> ❑Marine ❑ Agricultural ❑ Industrial generator to be economically Practicable. <br /> I hereby certify that I have read and have the authoK4 to =_ <br /> bind the above listed generator to the terms on the reverse <br /> Re n sample # '7 G i Z side of this form. <br /> )c 0 (Le <br /> Dri ignature Print Name Routc # Date enerator's Signature Prin ame Date <br /> �i <br /> 7r. t�C s •��r:"�'�+r�n+.*::m.?Yn..?_.�* :��as:__-..�:> «v,,*4,4�,. ,,... ... ..:, .. ,. ... ,.... <� :�ts:><rdb�.i4 <br />