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i _ WORK ORDER/SERVICE AGREEMENT <br /> J <br /> Evergreen Environmental Services $9041 <br /> A <br /> Wededicated 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 /> Dept.2457 <br /> 6690 S.S Ave.,Newark, rs EPA»CADEPA#C D9824 Date- <br /> 16540 S.San Pedro St.,Carson.CA EPAR CAD982413262 LOS Angeles,CA 90084-2457 <br /> GENER.ATOR130B LOCATION BILLING INFORMATION <br /> 07 <br /> NAM NAME - CASH E]CHECK <br /> AD ESS ADDRESS CU ER CODE NO. <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. 2 � <br /> PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> P ONE NO. 71 ( `- ) <br /> WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> PRODUCT CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lutiriiating,CA 221 1 f <br /> Waste;Liquid <br /> Industrial C Gal. <br /> uue Aman ,iu I6 Na RCRA N.maw: CAI34 Gaf. <br /> wp IJ 'a C, I Gai. <br /> 19411110,'1 wnumbimld J,hd.S.NA Fpal/FOm <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 /> DrumEmpty Drums <br /> Hrs. <br /> { Transportation <br /> Gal. <br /> Non Hazardous Water <br /> TEST: Clot D Tech 40002i�pm E] Our D Toch 1000 Pass EJ Fail ❑Halogen Detector7Flame Test <br /> E ❑ ai <br /> Fl ,MM <br /> Total Chaz es <br /> Field Service Work Description: <br /> Other: <br /> Other: - �/y <br /> 4-00vacuum Services Time • Q. <br /> Out of Yard On Site Off Site Off Load Start <br /> Off Load End Rcwm to d <br /> TSDF Consolidated Manifest <br /> Wvergrecn Oil,Inc. Evergreen Env.Svc_ Evergreen Env.Svc. El AIS Filler <br /> 1 ILYJ 6880 Smith Ave. El Road 306 4193 N.Valentine 15131 Clark Ave. _ <br /> Newark CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD990887418 CAD982446874 CAD982446882 CAD000097432 <br /> Evergreen Env.Svc. Evergreen Env.Svc. CFR <br /> ❑ CFR. Greenleaf Env.Svc. <br /> ❑ 16604 eco, Pedro 745 A West Bettemvia 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 Generatormitifres that it has established a prlogram to reduce the volume m <br /> Source: 'Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> generator to be economically pmcticabie. <br /> Marine ❑ Agricultural ❑ Industrial 1 hereby certify that 1 have read and have the authori�0 <br /> i jWbove listed eneratortothetermsonthereversfain sample # Y tn aD erSignature PrintName Route# ate Signature Print Natne DaG <br />