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WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services <br /> dedicated to the protection of the environment <br /> Send a went to: Sales Order ! <br /> 090, To schedule a pickup,call P Y <br /> 500-972-5284 Evergreen <br /> P.O.Box 49065 Date* <br /> 6680 Smith Ave.,Newark, rs .CA <br /> EPA*C 098241 3262 San Jose,CA 95161-9065 <br /> 16570 S.San Pedro St.,Carson.CA EPAJt CAD962413262 <br /> GENERATORMOB LOCATION BILLING INFORMATIONNAME CASH L]CHECK❑ <br /> NAME # <br /> CUSTOMER CODE NO. <br /> ADDRESS ADDRESS <br /> I <br /> CITY STATE 7.IP CO. CITY STATE ZIP CO. PO#PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PHONE NO. ) <br /> WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> PRODUCT CODE NUMBER <br /> Gal. <br /> Used oil,Non-RCRA Hazardous Lubricating CA 221 Gal. <br /> Waste,Liquid Industrial CA221 <br /> Uwd Atac d,e Aiwneae.Nan-RCRA Ne 1N 5 CA134 Gal. <br /> WM.V aid CA22I Gal. <br /> Rp W+NC Cambu hielaqui4 N O5.NA pwiffi 2 <br /> i ,aim aiaannm•nnea„,mw m. Gal. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Each <br /> Wash Out Drum <br /> I Drained Used Oil Filters Drum <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 <br /> Drum <br /> Empty Drums <br /> it Hrs. <br /> Transportation i! Gal. <br /> Non Hazardous Water <br /> TEST:❑Clor D Tech 4000----PPm ❑ Clor D Tech 1000❑Pass❑Fad ❑Halogen DetectorTlame Test []Pass ❑Fail <br /> Total Chaz es <br /> Field Service Work Description: <br /> I <br /> Other: <br /> '... Other: <br /> Vacuum Services Time <br /> Out of Yard On Site Off Site Off Load Start Off Load End Retum to Yard <br /> TSDF Consolidated Manifest <br /> Evergreen Env.Svc_ Evergreen Env.Svc. El AIS Filter <br /> ❑ Evergreen Oil,Ina B 4193 N.Valentine 15131 Clark Ave_ --� <br /> New rk.C Ave. Road 3C Fresno,CA 93711 Industry,CA 91745 <br /> Newark.CA 918 Davis, 24 95926 <br /> i CAD980887418 CAD982446874 CAD982446882 CAD000097432 �— <br /> ..� CFR. Greenleaf Env.Svc. <br /> ❑ Evergreen Env.Svc. Evergreen Env.Svc. CFR ❑ 3474'royon Circle <br /> 16604 S.San Pedro El 745 A West Betteravie 944 E.Siauson Ave. 33. Wenstem Valley Springs. <br /> Carson,CA 90746 Santa Maria,CA 93454 Los Anggeles,CA 90011 Union Ci CA 94587 CAL000214411 A 95352 <br /> CAD981696420 CAD982446858 CALOOOII0021 CAL000091507 <br /> Generator certifies that it has established,program to reduce the volume or <br /> [Source: ❑Collection Station ❑Government gentato&to be econotoxicity mically cal the y practicable. <br /> e to the degree determined by <br /> Marine El Agri <br /> ❑ Industrial 1 hereby certify that 1 have read and have the authority to <br /> bind the above listed veneratorto the terms on the reverse <br /> Retain sample# side-"'hs form. <br /> Driver Signature Print Name Route# Date Generator s Si¢nature Print Name Dale <br />