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WORK ORDER/SERVICE AGREEMENT <br /> 48 P Evergreen Environmental Services 90256 <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 f� <br /> 16.540 S.San PedroSt.,Carson,CA EPA#CAD982413262 Los Angeles,CA 90084-2457 Dat' <br /> GE TO JOB LOCATION BILLING LWRMIATION <br /> NAMEX CASH❑CHECK❑ <br /> q <br /> REQ ADDRESS C STOMER CODE NO. <br /> C / „t STA ZlgCIT - P COPO <br /> / � <br /> ZI <br /> PHONE N PHON ' APOFILENO. 1ST9M R EPA II NO. <br /> 2-7 <br /> .2- <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA 221 Gal. <br /> ! Waste,Liquid Industrial CA221 Gal. <br /> Uv Auw wjve Anffw Nm-RCRA IV ws CA134 Gal. <br /> WWe Li id <br /> RQ Wulc Combustible L"puid,N O s.NA CA211 <br /> 1993111 Oilcmamivlcd wiN W FaaIN002 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 ppm ❑Clm D Tech 1000❑Pass❑Fail ❑Halogen Detector/Flame Test ❑Pass ❑Fail O <br /> Field Service Work Description: S11A 21- jp Total Charges <br /> H © / <br /> 06e <br /> r _ / ! <br /> Vacuum Services Time <br /> l <br /> Out of Yard On Site Off Site Off Load Start Off Load End Return to Yard <br /> TSDF H Consolidated Manifest <br /> Evergreen Oil,Inc. ❑ Evergreen Env.Svc.. � Evergreen Env.Svc. ❑ AIS Filter <br /> 6880 Smith Ave. Road 306 4193 N.Valentine 15131 Clark Ave.. <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> !I CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. � CFR CFR. ❑ Greenleaf Env.Svc. <br /> 16604 S.San Pedro 745 A West Betteravia 944 E.Slauson Ave. 33210 Western 3474'royon Circle <br /> Carson,CA 90746 Santa Maria,CA 93454 Los Anggelcs,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696420 CAD982446858 CAL000I 10021 CAL000091507 CALOW214411 <br /> Source: El Collection Station C3 Government Generator certifies that it has established a program to reduce the volume or <br /> quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑ Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> 1 hereby certify that I have read and have the authority to <br /> bind the above listed generator to the terms on the reverse <br /> Retain sample # sid <br /> _eo is form.,-, <br /> i <br /> ver Signature Print Name Route# Date Generato s Signature Print Name Date <br />