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WORK ORDER/SERVICE AGREEMENT <br /> 80922 <br /> ergreen Environmental Services n <br /> dedicated to the protection of the environment Sales Order <br /> 410, To schedule a pickup,call Seed Pa3me°I t°' <br /> 800-972-5284 Evergreen <br /> P.O.Box 49065 Date- <br /> 6880 Smith Ave..Newark, CA EPA#CAD982413262 San Jose,CA 95161-9065 <br /> 16640 S.San Pedro SL,Carson,CA EPA#CAD982413262 BILL INFORMAT ON <br /> GENERATOR/JOB LOCATION N #ASH❑CHECK❑ <br /> ' <br /> NA ,- /� C O�E O. <br /> GV ADDRESS <br /> DD E <br /> ES /- <br /> Gr! <br /> AT � CO.� PON - <br /> CIT ST � ZIP CO. CITY <br /> 0 PHONE NO. PROFILE NO. 1 TOMER 11 P ID <br /> PHO N <br /> ( ) y oo v <br /> QUANTITY UNITS PRICE .AMO NT <br /> WASTE MANIFEST ;i <br /> PRODUCT CODE NUMBER <br /> Gal. <br /> Used oil,Non-RCRA Hazardous Lubricating CA 221 _ <br /> Gal. <br /> Liquid Industrial CA221 Gat. - <br /> "veMufir+SNarRCRAHav,Eaus CA134 Gat, <br /> w - ' CAIII <br /> "deli@u4 S.NA Po01/Fa03 Gal. <br /> RW]III P <br /> Oil&Water,N' ., A Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Slu Each <br /> Wash Out Drum <br /> Drained Used Oil Filters - Drum <br /> Non-RCRA H Its Waste Soli i%debris) CA223 <br /> Or <br /> Empty Dru - His. <br /> Transportatio Gal. <br /> Pass Fail ❑Halogen Detector/Flame Test ❑Pass ❑Fail Otal C <br /> TESTED]Clor D Tech 4000_JIPrn ❑Clor Tech I ❑ <br /> Field Service Work Description: <br /> r: <br /> Vacuum Services Time OR Load Start Of Load End Return to Yard <br /> Out of Yard On Site Off Site <br /> Consolidated Manifest {u^ <br /> TSDF <br /> Evergreen Env.Svc.- Evergreen Env.Svc. AIS Filter <br /> I Evergreen Oil,Inc. Road 30B ❑ 4193 o Valentine 15 131Indus Clark Ave <br /> - <br /> ❑ 6880 Smith Ave. Fresno,CA 93711 Industry.CA 91745 <br /> Newark,CA 94560 Davis,CA 95926 CAD982446882 CAD000097432 `p <br /> CAD980987418 CAD992446874 t nv. c. <br /> I Evergreen Env.Svc. <br /> Evergreen Env.Svc. <br /> ❑ CFR CFR' 3474 Toyon Circle <br /> 352 <br /> ❑ 16604&San Pedro 745 A West Betteravia 944 E.Slauson Ave. - 3321Union City,C CAL000214411 <br /> Carson,CA 90746 Santa Maria,CA 93454 Los Angeles,CA 90011 L000091 5 07 94587 Valley Springs,CA m to reduce the volu <br /> CAD982446858 CAL000110021 <br /> CAD981696420 G amity r certifies that it has established to th <br /> !I Source: C]Collection Station ❑Government <br /> generatorto be toxicity <br /> economically practicabus le.waste to the degree determined M <br /> Agricultural ❑ Industria] <br /> ❑ Marine ❑ $ 1 hereb certif that I have read and have the authonl <br /> bind the ab isled ene for to the terms on the rel <br /> II <br /> Retain s pie # side of t ' rm. <br /> � ; <br /> rO � <br /> int Name Route# Date <br /> eneratot's in_nature Print Name <br /> I� Dr erSienatiire <br /> I <br /> II I`'---- —>=vSPnr9eiF5"LA-gQ0$ 25r Total Invoice Balance <br /> Customer Original (Reprinted) Page <br />