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WORK ORDER/SERVICE AGREEMEN <br /> green Environmental Services 90270 <br /> dedicated to the protection of the environment <br /> To schodule a pickup,call Send payment to: Sales Order if <br /> 800-972-5284 Evergreen Oil,Inc. <br /> Ave..Newark CA EPA#CADW413262 Dept 2457 > <br /> San Pedro SL,Carson,CA EPA#CAD9a2413262 Los Angeles,CA 90084-2457 Date. <br /> 'RATOR/JOB LOCATION BILLING INFORMATION <br /> E NAME. . ` - CASH❑CHECK❑ <br /> AD,ORESS - ADDRESS - ,USTOMERCODYNO. <br /> CITY Z[P. 'CO. CITY STATE ZIP CO. PO ,..; fi^ sw <br /> PHONE`NO. PHONE NO., PROFILE NO. 'USTOMER EPA ID NO. <br /> -. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Now RCRA Hazardous Lubricating CA 221 Gal' <br /> Waste,Liquid Industrial CA221 Gal. <br /> U: Amomoti.e Ao fr N RCRACA134 Gal. <br /> W. 4ad cAui <br /> RQ W+ CvnbutibRLiquid NO.a.NA miRU02 Gal. <br /> 1"3 W Oil cmumbwd,.,rh hrl - <br /> oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> Wasb Om Each <br /> Drained Used Oil Fitters e Down -- <br /> Nor-RCRA Hazardous Wane Solids(oily debris) CA223 Drum <br /> Empty Danns Drum <br /> Transportation Hot. <br /> Non Hazardous Water Gal. <br /> TEST:❑Cbz D Tech 4000�pm ❑Clor D Tech 1000❑Pass❑Fail ❑Halogen Detectar/Flame Test ❑Pass ❑Fail <br /> Field Service Work Description: TotalChar es <br /> s <br /> Other. <br /> ourr. <br /> Vacuum Services Time <br /> Out of Mandk.On Site Off Si& Off Load Start _ Off Load Erld Rehm to Yard <br /> TSDF Consolidated Manifest <br /> r (� <br /> ❑ Evergreen Oil,Inc. ❑ Evergreen Env.Svc.. ❑ Evergreen Erw.Svc. ❑ AJS Filter V I <br /> 6880 Smith Ave. Road 30B 4193 N.Valentine 15131 LJ <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 1 5 <br /> CAD980897419 CAD982446874 CAD982446882 7432 <br /> ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑CFR CFR. ❑ Greenleaf Env.Svc. <br /> 16604 S.San Pedro 745 A West l3etleravia 944 E.Slauson Ave `33210 Western 3474 Toym Circle <br /> Carson,CA 90746 Sarna Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696420. CAD982446858 CAL0001I0021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: El Collection Station LJ GDYerntnent quantity,&toxicity of the hazardous waste to the degree determined by <br /> E) Marine ❑AgriCulttltal 0 Industrial generator to be economically practicable. <br /> I hereby,certify that 1 have read and have the authority to <br /> bind the above listed generator to the terms on the reverse <br /> Retain sample# side of this form. <br /> Date <br /> Driver Signature Print Name - Route# Date Generator's Signm <br /> Signature Print Nae <br />