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WORK ORI"R/SERVICE AGREEMENT <br /> -- <br /> Evergreen Environmental Services 80948 <br /> ,3 Send dedicated to the protection of the environment Sa <br /> 7 <br /> To schedule a pickup,call Pa).meot to: les Order <br /> 800-972-5284 Evergreen <br /> P.O.Ros 49065 Date' <br /> 6880 Smith Ave.,Newark. CA EPA#CAD982413262 San Jose,CA 95161-9065 <br /> 16540 S.San Padm St,Carson,CA EPA#CAD982413262 BILLING NFORMATION <br /> GEN TOWJOB LOCATION NAM /^ CASH❑CHECK❑ <br /> N <br /> ADD SS RCODE NO. <br /> A DRESS ST /_C ! Y <br /> Gd�6-a TATE Z CO. CITY <br /> CIT (q/e(" <br /> /t • PROFILE NO. USTOMER EPA ID NO. ry <br /> (PW <br /> NO. PHONE NO. <br /> O VX <br /> WASTE MANIFEST QUANTITY kNITS PRICE AMOUNT <br /> PRODUCT CODE NUMBER , <br /> Gal_ <br /> Used oil,Non-RCRA Hazardous Lubricating CA 221 Gal. <br /> Waste,Liquid - . Industrial -CA221 <br /> W AulmwUvc A„urnzzc Non-0.CRA Ihmdwu CAI34 Gal <br /> _ <br /> RQ WurcC9,n .,.lignd,N0.5.NA -F091IFW2 <br /> 199)111 <br /> I..,. c^la hY <br /> Oil&Water,Non-RCRA Hazardous,Waste Liquid CA221 al _ <br /> Waste Solids and Studges Each 1 <br /> Wash Out Dram <br /> Drained Used Oil Filters Dmm <br /> Non-RCRA Haran m Waste Solids(oily debris) CA223 Drum C / <br /> Empty Drams lS His. 3 <br /> Transportation Gd. <br /> Non Haz,ardous Water <br /> TEST:❑CIor D Tech 4000­11pri ❑CIor D Tech 1000❑Pass❑Fail ❑Halogen Detector/Flame Test ❑Pass ❑Fail TO aC es <br /> Field Service Work Description: <br /> 60 /I o <br /> r. C It <br /> Vacuum Ser,," es Time - _ <br /> tum to Yard .. <br /> out of Yard On Site Off Site Off Load Start Off Load End Retain <br /> ManifeSt <br /> TSDF <br /> ❑ <br /> lter <br /> Evergreen Oil,Inc. Evergreen Env.Svc.. El 4193 N°Valentinec 15131 AJS 1Clark Ave_6880 Smith Ave. Road 306 Fresno,CA 93711 Industry,CA 91745 <br /> Newark CA 94560 Davis,CA 95926 C esno,C 937 CAD000097432 �O <br /> CAD980887419 CAD982446874 <br /> w�I CFR. - v.Svc. <br /> Evergreen Env.Svc. Evergreen Env.Svc. CFR �r—f, .3474 To on Circle <br /> ❑ 16604 S.San Pedro 745 A West Betteravia 944 E.Slauson Av . -`—+33210 Western Toy <br /> on <br /> CA 90746 Santa Maria,CA 93454 Los Ang1 es,CA 90011 UnionAL0City,CA 94587 CAL000214411CA 95352 <br /> CAD981696420 CAD982446856 Generator certifies that it has established a program to reduce the volume or <br /> Source: ❑Collection Station ❑GovernMent quantity <br /> toxicity <br /> aty of economically hazardous <br /> p acus waste to the degree determined by <br /> ❑ <br /> Marine ❑ Agricultural ❑ Industrial 1 hereby certify that 1 nave read and have the authority to <br /> bind the abov fisted ener E r to tl a terms on the reverse <br /> ;1D) t4verSiFnakture <br /> mple # side oft <br /> yn Print Name /N Route# Date <br /> Ge era s Sip <br /> Prin Name ate <br /> �tfs-TKnge a Cs A 09 084-2457 ess aid Amount 0 00 <br /> �T Totallnvoice Balance =355.00 <br /> Customer Original(Reprinted) Page 1 <br />