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WORK ORDErjSERVICE AGREEMENT <br /> %480 i Evergreen Environmental Services <br /> No 205925 <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: Sales Order # <br /> 800-972-5284 Evergreen Oil, Inc. <br /> BOX 678252 <br /> P.O. � )�-)� <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Date: ! � <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 <br /> Dallas,TX 75267-8252 GE BILLING INFORMATION RATOR/JOB LOCATION NAME CAS CHEC <br /> NA E # <br /> ADDRESS ADDRESS C STOMErV <br /> q CODE NO. <br /> CI Y <br /> STATE ZIP CO. CITY STATE ZIP CO. PO# V <br /> PHONE. NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PH NE NO. y�s <br /> ( > G4 � <br /> 00 9 <br />�I WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> PRODUCT CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 3 1B <br /> Gal. ► <br /> Waste,Liquid <br /> Industrial CA221 Gal. w <br /> Used Automotive Mtifrceze,Non-RCRA Hazardous CA 1 34 Gal. <br /> i� Waste Li uid CA221 Gal. <br /> IJ RQ Waste Combustible Liquid,N.O.S.NA Fool/r002 <br /> lI1993 ut Oil contaminated with halo ens Gal <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 <br /> Gal. e- <br /> Waste Solids and Sludges <br /> Each <br /> Wash Out Drum ` a <br /> Drained Used Oil Filters *; <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum , <br /> Drum <br /> Empty Drums <br /> Hrs. " <br /> Transportatio <br /> Gal. <br /> i Non Haza ous Water <br /> TEST: ' Clor D Tech 4000Z�ppm ❑Clor D Tech 1000 Pass❑ Fail ❑ Halogen Detector/Flame Test E]Pass E]Fail Z=_—=PQ <br /> I Total Char es <br /> YY Field Service Work Description: <br /> �I <br /> J' Other: <br /> t Other: <br /> Vacuum Services Time <br /> Out o and On Site Off Site Off Load Start <br /> Off Load End Return to Yard <br /> TS F Consolidated Manifest <br /> Evergreen Oil,Inc. ❑ Evergreen Env.Svc. El <br /> Evergreen Env.Svc. ❑ 51 Filler <br /> ❑ <br /> 1 6880 Smith Ave. Road 30B Fres N.Valentine 1no,CA 93711 Indus <br /> Clark Ave. <br /> Newark,CA 94560 Davis,CA 95926 Fresustry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CADW0097432 <br /> ❑ CFR Greenleaf Env.Svc. <br /> ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ CFR ❑ 3474 To on Circle <br /> 16604 S.San P dro 745 A West Betteravia 944 E.Slauson Ave. 33210 Western Toyon <br /> Carson,CA 9 46 Santa Maria,CA 93454 Los Angeles,CA 90011 union City.5(17 CA 4587 CAL000Springs, <br /> 1441 1 CA 95352 <br /> 115 CAD98169 0 CAD98244685g CAL00011(H)21 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station ❑Government quantity x toxicity of the hazardous waste to the degree determined by <br /> 1+ generator to be economically practicable. <br /> ❑ Marine ❑ Agricultural Industrial 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 /> FIIi R ain sample # G <br /> i <br /> side of this Form. <br /> psi <br /> oi <br /> ch' <br /> er SDate Generator's Signature <br /> Signature rint Name Route# Print Name Date <br /> 30� <br /> 1 <br /> .j <br /> i <br /> 'i I� <br />