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oWORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services <br /> dedicated to the protection of the envrronnie'nt NO 169846 <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: S <br /> GE RATOR/JOB LOCATION BILLING INFORMATION <br /> NA E NAME CASH EC <br /> # l� <br /> ADDRESS 10ra <br /> ADDRESS CUSTOME CODE NO. <br /> JA <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. # <br /> s <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> ) -a c t 0 <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE <br /> CODE NUMBER AMOUNT <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 er–D Gal. $ t <br /> Waste,Liquid Industrial CA221 Gal. • <br /> Used Automotive Anliftme,Non-RCRA Hw—dous <br /> Wane Liquid <br /> CAI 34 <br /> Gal. <br /> RQ Waxte Combustible Liquid.N.O.S.NA CA221 <br /> 1993 III Oil contaminated with halo enc F00J1 Yx)2 Gal. <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-RCRA Hazardous Waste Solids(oily debris) CA223 <br /> Drum <br /> Empty Drums <br /> Drum <br /> Transportatio <br /> Hrs. <br /> Non Haz us Water Gal. <br /> PEST: Clor D Tech 4000.2-2ppm Clor D Tech 1000 Pass❑Fail Halogen Detector/Flame Test ass ❑Fail sp <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum Services Time <br /> Out of ard On Site Off Site Off Load Start Off Load End Ret ni to Yard O I 00 <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 1:115131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Ind ustry,WCA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAUR(IN <J7432 <br /> EEvergreen Env.Sv . ❑ Evergreen Env.Svc. ❑ CFR CFR ❑ Greenleaf Env.Svc. <br /> 16604 S.San Pe o 745 A West Betteravia 944 E.Slauson Ave. 33210 Western 3474 Toyon Circle = ' <br /> Carson,CA 90 6 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CA 998169 0 CAD982446858 CAL000110021 CAL000t)91507 CALW0214411 <br /> Source: Collection Station Ll Government Generator certifies that it has established a program to reduce the volume or <br /> 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 authority to <br /> ain sample # 3 G bind the above listed generator to the terms on the reverse <br /> side of this form. <br /> J <br /> Iver Signature Print Name Route# thtte� �Gerator's Signature Print ime Date <br /> 1 , <br />