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WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services/ No 165 3 7 7 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 /> 6880 Smith Ave.,Newark.CA EPA#CAD982413262 P.O. BOX 678252 / ,.,TZ-316540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Dallas, TX 75267-8252 Date:/L/6�V <br /> GENE TOR/ OB LOCAT ON BILLING INFOR ION <br /> NAM NAME �J/ CASH❑ CHECK❑ <br /> f�ill�'ti # <br /> DRF ADDRESS �Z CODE O. <br /> C'iT ' QTAT 7y1 CO. CITY STATE ZIP CO. PO# 1196,0 <br /> P �'F, NO. PHO E NO. PROFILE NO. <br /> tr <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Dred oil.Nun-RCRA Hazardous Lubricating CA221 Gal. <br /> Waae.Liquid Industrial CA221 Gal. <br /> t.vJ Nnnm,uiw A.,ft r.Non RCR\1C.1—lou, CAI 34 G:II. <br /> \4.ntr Le n,A <br /> Rp 1.111,eomM,11b1r 141,id.[U S N o CA"_I <br /> 1111111,1. nN„eh AJ... FIYII,I'IM` G`11- <br /> Oil& Water.Non-RCRA Hazardous W;lSte Liquid CA221 Gal. <br /> N rile Subde and Sludges Gal. <br /> Wash Out Each <br /> Drained Used Oil Filters Drum <br /> N,,n RCRA Hazardous Waste Solids(oily dehrm CA22 i Drum <br /> limply Drum, Drum <br /> Trmsix)rtation Hrs. <br /> Nnn Hazardous Water Gal. t <br /> TEST:❑ Clor D Tech 4000 ppm ❑Clor D Tech IOOOE]Pass ❑ Fail ❑ Halogen Detector/Flume Test ❑Pass ❑ Fail <br /> Field Service Work Description: Total CharLres <br /> Other: <br /> Other: <br /> Vacuum Services Time <br /> Out of Yard On Site Off Site Off Load Stu Off Load End-Return to Yard <br /> TSDF Consolidated Manifest <br /> ❑ Evergreen Oil.Inc. Evergreen Env.Svc. Evergreen Env.Svc. ❑ AIS Filter <br /> 68.10 Smith Are. Road 30B 4139 N. Valentine 15131 Clark Ave. <br /> Newark,CA 94560 Davis.CA 95926 Fresno.CA 93711 Industry,CA 91745 <br /> CAD980887419 CAD982446874 CAD981_446882 CADO00097432 <br /> Evergreen Em.Svc. Evergreen Env.Svc. ❑ CFR CFR Greenleaf Env.Svc. <br /> 16604 S.San Pedro 745 A West Beoemvia 944 E.Slauson e. 33210 Western 3474 Toyon Circle <br /> Carson,CA 90746 Santa Maria,CA 93454 Los Angeles, 9 Union City,CA 94587 Valleyy S�ringgs,CA 9535'_ <br /> CAD98I696420 CAD982446858 CAL01101100_1 CAL000091507 CAL000 14711 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: ❑Collection Station C3 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 authority to <br /> bind the above listed Venerator to the terms on the reverse <br /> Retain sample side f this form. <br /> DriverXgnaftfre I t Name Route# Date erator's Signature Print Name Date <br />