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WORK ORDF ;ERVICE AGREEMENT <br /> Evergreen Environmental Services No 17 9 6 2 3 <br /> dedicated to the protection of the ernirnnnurrt <br /> . 44 <br /> To schedule a pickup, call Send payment to: Sales Order# <br /> 800-972-5284 Evergreen Oil, Inc. <br /> P.O. BOX 678152 <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dale: <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 BDI ZING X 7526 -8252 <br /> I <br /> ('ENERATORMOB LOCATION LLICASH CH CK <br /> NAME <br /> AME # d <br /> �' CU TOM R CODE NO. <br /> ADDRESS r ` <br /> ADDRESS U <br /> STA'rF, ZIP CO. CITY STATF. Z1P CU. PO# <br /> CITY <br /> PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PH NE NO. <br /> WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> PRODUCT CODE, NUMBER <br /> Gal. <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 <br /> h <br /> Waste,Liquid <br /> Industrial CA221 Gal. <br /> Use)Automotive Antifrceve.Non-RCRA HurrrJtmx <br /> CA 134 Gal. <br /> Watc Li uid (•A221 Gal. <br /> RQ Wnstc Combuxtibk LiquiJ,N.O.S.NA IgNll/MINI? <br /> 1991 111 oil contaminate)with holo cox Gal. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Each <br /> Wash Out Drum <br /> Drained Used Oil Filters Drum <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 <br /> Drum <br /> Empty Drums Hrs. <br /> Transportatio Gal. <br /> Non Haza ous Water <br /> TEST: Clot D Tech 40(x) _ppm ❑Clor D Tech 1(1(x1 Pass❑Fail E] Halogen DetectodFlame Test ❑Pass ❑ Fail D-OD <br /> Total Char es <br /> Field Service Work Description: <br /> 2 <br /> Other: <br /> Other: <br /> Vacuum S ices Time <br /> tT <br /> On Site Off Site OLoad Start Off Load End Return to Yard <br /> Out of and Consolidated Manifest <br /> rr F <br /> Evergreen Oil,Inc. Evergreen Env.Svc. ❑ Evergreen <br /> ver r en Env.iSvc ❑ AJS 1.5131 Filter <br /> Ave. ❑ — <br /> 6880 Smith Ave. ❑ Road 30B - <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Cdusir(xl A 91745 <br /> CAD980887418 CAD982446874 CAD98_44688_ <br /> ❑ CFR 32 Greenleaf Env.Svc. <br /> ❑ Evergreen Env.S ❑ Evergreen Env.Svc. ❑CFR ❑ 3474 To on Circle <br /> 166(14 S.San P ro 745 A West Betteravia 944 E.Slauson Ave. 33210 WestUniern Toy <br /> on <br /> CA 9 46 Santa Maria,CA 93454 Los Angeles,CA 9(x11 I CALOtNNI)I I07 94587 CAL(x10214411 CA 95352 <br /> 8IC CAD98169 0 CAD982446858 CALIxx)II(x121 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station ❑Government quantaltt&toxicity <br /> o xi it of the hilzly prdous waste to the degree determined by <br /> s ❑Marine ❑ Agricultural ❑ Industrial I hereby certify that I have read and have the authority to <br /> bind the above listed enerator to the terms on the reverse <br /> side or this form, <br /> s Re n sample # --f— <br /> Date y <br /> Dri ��r SignaturC Print Name <br /> Route# I Date enerator's Signature Print Name <br />