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WORK ORDER RVICE AGREEMENT"' •'" <br /> J 220605 <br /> J <br /> Evergreen Environmental Services NOR <br /> dedicated to the protection of the environment <br /> payment to: Sales Order # <br /> To schedule a pickup, call Send pay <br /> 800-972-5284 Evergreen Oil, Inc. <br /> P.O. BOX 679252 C f�)P <br /> CA EPA# <br /> 6880 Smith Ave.,Newark, CAD982413262DaTX --T- <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 BILI LING INFORMATION CA <br /> GEN ATOR/JOB LOCATION CA C <br /> � NAME # <br /> NAM <br /> ,.✓ CU.'fO�gE CO'DF,NO. <br /> ADDRESS <br /> A R'SS `�---- <br /> S � ZIPCO. CITY STA"f F. 7.1P CO. PO# <br /> CIT STATE <br /> PROFILE.NO. CUSTOMER EPA ID NO. <br /> PHONE NO. <br /> PHONE NO. ( ) <br /> WASTE MANIFESTAMOUNT <br /> QUANTITY UNITS PR10E <br /> PRODUCT CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Gal. <br /> Waste,Liquid <br /> Industrial CA Cal. <br /> Used Automotive Antifreen.Non-RCRA Hasarduns CA 134 <br /> Gal. <br /> Waste Li uid CA221 <br /> RQ Wuste Cumhustjmc Liquid.N.'.,e <br /> .S.NA 10MIRM12 <br /> 199}In oil contaminated with halo ens Gal. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> i Waste Solids and Sludges Each <br /> Wash Out Drum <br /> i Drained Used Oil Filters <br /> Drum <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum <br /> Empty Drums Hrs. <br /> Transportation Gal. <br /> t. <br /> Non Hazar us Water <br /> rIF, PPm ❑Clor VQ <br /> D Tech 1000 Pass❑Fail E] Halogen Detector/Flame Test ❑Pass Fail Total Char es <br /> QST: Clor D Tech 4000 <br /> Field Service Work Description: <br /> I(" <br /> Other: <br /> Other: e�A <br /> Vacuum S ices Time Returnto Yard I <br /> Out of rd On Site Off Site Off Load Start <br /> Off Load End <br /> 1 Consolidated Manifest <br /> "rs Evergreen Oil,Inc. Evergreen Env.Svc. Evergreen Env.Svc. ❑ j5131 JS Filter <br /> Ave. <br /> 6880 Smith Ave. ❑ Road 30B ❑ Fres o, Valentine indust CA 91745 <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 industry, <br /> CAD982446882 CAD000097432 <br /> CAD980887418 CAD982446874 ❑ Greenleaf Env.Svc. <br /> r ❑ CFR <br /> 3474 Toyon Circle <br /> Evergreen Env.Sv . ❑ 745rA�"e t Betteravia❑ 44 E.Slauson Ave. 33210 Western Valle Springs,CA 95352 <br /> II ❑ 16604 S.San Pe o CAL000214411 <br /> Carson,CA 90 6 Santa Maria,CA 93454 Los Angeles, 1 9001 I CA�� '�yi 0�94587 Y <br /> I CAD982446858 CAL000110021 <br /> CAD98169 0 Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> Industrial generator to be economically practicable. <br /> i, ❑Marine L) Agricultural <br /> ❑ I hereby certify that I have read and have the authority to <br /> bind the above listed enerator to the terms on the revers <br /> ' side of this rm. <br /> e in sample # <br /> Tint Name Route# Mate <br /> eneraror's Signature <br /> Print Name Date <br /> 1 er Signature <br /> b ' <br /> i <br /> r <br /> c <br /> i <br /> i <br /> ji <br /> t' <br /> , <br />