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j WORK ORDER/SERVICE AGREEMENT <br /> L -�--rgreen Environmental Services 8 <br /> dedicated to the protection of the environment - <br /> 6332 <br /> wv <br /> To schedule a pickup,call Send payment to: Sales Order# <br /> 800-972-5284 Evergreen Oil,Inc. <br /> 6860 Smith Ave.,Newark, CA EPAN CAD982413262. Dept.2457 <br /> 16540 S.San Pedro St.,Carson,CA EPAN CAD982413262 Las Angeles,CA 90084-2457 Date:i::1► <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NAME 1 NAME CASH❑CHECK❑ <br /> # <br /> A R ;- ADDRESS CUSTOMER <br /> CODE NO. <br /> CI Y TATE ZIP CO. CITY STATE ZIP CO, pp# <br /> PHONE NO. PHONE NO. PROFILE NO. C Ru&t- ^—M`t <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA 221 -21LI14KIIs Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> utdgw.Anhfm No ACRAHu . CAI34 � :•., <br /> Gal. i l <br /> RQw. Cavbuable❑qwA NOS.NA CAPdi <br /> rearm ai mmmmee vArA t..') zoo mom 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 Drum <br /> Empty Drums Drum <br /> Transportation Hrs. <br /> Non Hazardous Water Gal <br /> TEST:YClor D Tech 4000'6', ppm ❑Clor D Tech 1000 ass❑Fail ❑Halogen Detector/Flame Test ❑Pass ElFail <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> vacuum Services Time <br /> Out of Yard On Site Off Site Off Load Stan Off Load End Retum to Yard <br /> TSDF Consolidated Manifest <br /> t Evergreen Oil,Inc. L] Evergreen Env.Svc- Evergreen Env.Svc. ❑ AJS Filter F-1L-1 6880 Smith Ave. Road 36B 4193 N.Valentine 15131 Clark Ave.. <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> Evergreen Env.Svc. Evergreen Env.Svc. ❑ CFR ❑ CFR. ❑ Greenleaf Env.Svc. <br /> 16604 S.San Pedro 745 A West Beheravia 944 E.Slauson Ave. 33210 Western 3474 Toyon Circle <br /> Carson,CA 90746 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696420 CAD982446858 CAL000110021 CAL000091507 CALOOD214411 <br /> Source: Collection Station ❑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 /> 1 hereby certify that 1 have read and have the authority to <br /> Retain sample # f bind the above listed venerator to the terms on the reverse <br /> side of this form.- <br /> ( f <br /> DriverSienature Print Name Route# Date (3enerator'sSienature Print Name Date <br />