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WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services N° 85332 <br /> dedicated to the protection of the environment / f —7 Z 3 <br /> f Send payment to: Sales Order 1010 I <br /> To schedule a pickup,call P Y <br /> 800-972-5284 Evergreen Oil,Inc. <br /> 1654 Smith Ave.,Newark, rs EPAN CAD915 2 <br /> Dept.2457 DateA3113Jo2 <br /> 16544 S.San Fedor SL,Gerson.CA EPAN CAD982AD962413262 Los Angeles,CA 9110&1-2457 . <br /> CENERATOR/JOBLOCATION <br /> BILLING INFORMATION CASH E]CHECK E]NAME <br /> NA E N <br /> CUSTOM R CODE NO. <br /> ADDRESS <br /> ADDRESS 00Z <br /> STATE ZIP CO. CITY STATE ZIP CO. PON <br /> C V gN . <br /> PHONE NO. <br /> PROFILE NO. C <br /> PHONENO. <br /> WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> PRODUCT CODE NUMBER <br /> Gal. <br /> Used oil,Non-RCRA Hazardous Lubricating CA 221 <br /> Gal. <br /> Waste,Liquid Industrial CA221 <br /> Ued Nnm,d,�c Andaers.Nm-RCM Hsu,dan <br /> CA134 0 Gal. J <br /> Wore V d CA221 Gal. <br /> RQ Wage fomMeriNeliQui4 N.O 5.NA FW IIFW2 <br /> wnnn al wnl.,n,omd..+m w <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal <br /> Waste Solids and Sludges Each <br /> Wash Out Drum <br /> Drained Used Oil Filters Drum <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 <br /> Drum <br /> Empty Drums Hrs. <br /> Transportation Gal, <br /> Non Hazardous Wateri <br /> TEST P(CI.,D Tech 4000J�.1 pPrn ❑Clot D Tech 10(10 Pass❑Fad E]Halogen Detector/Flame Test ❑pass ❑Fail TOtal Charges <br /> Field Service Work Description: <br /> Other. <br /> Other: P1 GO <br /> Vacuum Services Time Off Load End Rehm to Yard <br /> Out of Yard On Site OS Sile OB Load Start <br /> Consolidated Manifest <br /> TSDF <br /> ��_(1/Evergreen Oil,Inc. Evergreen Env.Svc.. Evergreen Env.Svc. 0 AIS Filter <br /> Y-U 6880 Smith Ave. El Road 30B 4193 N.Valentine 15131 Clark Ave..Fresno,CA CA 93711 Industry,CA 91745 <br /> Newark,CA94560 Davis, 95926 CAD982446882 CAD000097432 ---�� <br /> CAD986987418 CAD982446874 <br /> ❑ CFR. Greenleaf Env.Svc. <br /> Evergreen Env.Svc. Evergreen Env.Svc. El CFR 3474 To on Circle <br /> ❑ 16604&San Pedro 0 745 A West Beaeravia 944 E.Slauson Ave. 33210 WestCA ern Toyon <br /> Carson,CA 90746 Santa Maria,CA 93454 Los CA 0001 0021 9(1011 union CAL00009I50794587 CAL000214411CA 95352 <br /> CAD981696420 CAD982446859 Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> generator to be economically practicable. <br /> Marine 0 Agricultural ❑ Industrial I hereb cer-fv that 1 have read and have the authority to <br /> / bind the above listed enerator to the term on the reverse <br /> Ret sample # f> side of this form- <br /> Ret <br /> s <br /> )B 8 <br /> D <br /> Driv, Sil=-nature rintName Route Date eneratolSSi¢nature Print Name <br /> - <br /> Total Invoice Balance 35 <br /> Customer Original(Reprinted) Page 1 <br />