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osr J'2/ �\ <br /> WORK ORDER/SERVICE AGREE <br /> ,men Environmental Services <br /> dedicated to the protection of the environment ^' <br /> To schedule a pickup,call Send payment to: Sales Order <br /> 800-972-55284 Evergreen Oil,Inc, <br /> i 6680 Smith Ave.,Newark, CA EPA#CAD982413M Dept,2457 / <br /> 16540 S.San Pedro SL,Carson,CA EPA#CAD962413262 Los Angeles,CA 90084-2457 Date• -J , <br /> t( GENE *TbWJOB LOCATION_ BILLING.INFORMATION <br /> NA3 t P.' - NAME- CASH❑CH <br /> It <br /> { 71DDRE8S -'' y ADDRES3;� Z ._^, <br /> ti. " .6"50 ERC <br /> 06TATE* �1 -,! CO. CITY..* ..t �fA'T -1 P CO. POO �G <br /> F v� <br /> i PEON O.V14 *y '} ,,.- PHONE NO. PROFILE NO. ER EI <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOU <br /> Used oil,Nal-RCRA Hazardous Lubricating CA 221 Gal <br /> Waste,Liquid Industrial CA221 Gal. <br /> Ua,sl AutmmUvc Antinxs,N9a-RCM Hamduu <br /> waneu�a CAM Gal. <br /> aQ W.Com W.ligiuq N.O S.NA CAM' <br /> 1991 In Oil—.iiwrdw W miffila2 Gal. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal <br /> Waste Solids and Sludges Gal <br /> Wash Out <br /> Each <br /> Drained Used Oil Filters - Dorn <br /> NowRCRA Hazardous Waste Solids(oily debris) CA223 <br /> Empty Drums <br /> m <br /> Transportation Hrs. <br /> Non Hazardous Water Gal. <br /> i <br /> TEST:❑Clor D Tech 4000_ppn ❑Clor D Tech 1000❑Pass❑-Fail ❑Halogen Detector/Flame Test ❑Pass ❑Ful <br /> Field Service Work Description: - <br /> 3 Total Cha <br /> ~_ -ag� .<. 14!2 Zi;tr, <br /> 1•'Sl.aj Other: F <br /> 2126 vacuum Services Time <br /> Out of Yard On Site Off Site Off Load Stan Off Load End two to Yard <br /> TSDF LJ Consolidated Manifest <br /> ❑ Evergreen Oil,Inc. Evergreen Env.Svc.. Evergreen Env.Svc. AJS Filler , 1'f 'A <br /> 6880 Smith Ave. ❑ Road 308 ❑4193 N.Valentine 1:1I S I3I Clark Ave.. `` '- a <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 , �,1. v,• A�y <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 Ar <br /> ❑ v Svc. <br /> Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ CFR ❑ CFR 1 <br /> 16604 S.San Pedro 745 A West Betteravia 944 E.Slauson Ave. 33210 Western re4 Toy n <br /> Carson,CA 90746 Santa M 3474 Toyon Circle <br /> CAD981696420 CAD98244685893454 ngcll 90011 CAL000091507�587 CALW0211'tCA 95352 <br /> { 101 <br /> Generator certifies that it has established a program to reduce the t <br /> Source: ]Collection Station ❑Government <br /> quantity&toxicity of the hazardous waste to the degree determine <br /> ❑ Marine ❑Agricultural ❑ Industrial generator to be economically practicable. <br /> 1 hereby certify that 1 have read and have the authc <br /> Retain sample # bind the above listed generator to the terms on the <br /> F <br /> side of this form. <br /> Drivef Signature frint Name Route# Date Ge erator's Signature Print Name <br />