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WORK ORDERISERVICE AGREEMENT <br /> %, Evergreen Environmental Services N° 94634 <br /> dedicated 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 /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept. 2457 <br /> 16540 S.Sen Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles, CA 90084-2457 Date: /014a1 =7_ <br /> GENERATOR/JOB LOCATION BELLING INFORMATION <br /> NA NAME CASH E]CHECK E] <br /> M <br /> A13DRESS ADDRESS CUSTOMER CODE NO. <br /> So. D <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. PO <br /> C-4 QJ Zara '_ZCZ b <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> &14) —Z I I c.4"CQZriZl3 <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 7_175'411075-Z9fa 3 SD Gal. e <br /> Waste,Liquid Industrial CA221 Gal. <br /> 7FMW Lpguid arc Awacee.NvmRCRA IremEouz CA134 Z t 7S7L68 Zso Gal. � � <br /> Ware uie �-Z.1 �{ <br /> RQ W—C ., L,, wmNA CAY21 <br /> ..rni aav !Aon Gal <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 /> Empty Drums Drum <br /> Transportation Hrs. <br /> Non Hazardous Water Gal. <br /> TEST:Clor D Tech 4000_A? ppm ❑Clor D Tech 10001WIPass❑Fail ❑ Halogen Detector/Flame Test ❑Pass Fail %'C� <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum Services Time <br /> Out of Yard On Site-Off Site_Off Load Start Off Load End Return to and <br /> 0 <br /> TSDF MCOnsolidated Manifest <br /> Evergreen Oil.Inc. Evergreen Env.Svc. 1:1 Evergreen Env.Svc. AJS Filter _ <br /> 6890 Smith Ave. Road 30B 4193 N.Valentine 1 1 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980897418 CAD982446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen Env.Svc. Evergreen Env.Svc. CFR CPR Greenleaf Env.Svc. <br /> 16604 S.San Pedro 745 A West Betteravia 944 E.Los AngSglauson Ave. 33210 Western 3474 Toyon Circle <br /> CAD9Carson816%420CA � CAM82446858 Sears Maria,CA 93454 C' L000110021A 90011 Cnio y1507 CA 94587 CAValley _14 fl i CA 95352 <br /> Source: QfCollection Station Ll Government Generator certifies that it has established program gr reduce the volume or <br /> quantity&toxicity of the hazardous wastea to the degree determined by <br /> ❑Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> q I hereb ser ` that I have read and have the authorityto <br /> R in sample # / G �.� Z bind the o list d rator to the terms on the reverse <br /> side of <br /> }� i oZ <br /> ver Signature Print Name Route# Date ene Is Signature Print Name Date <br />