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WORK ORDER/SERVICE AGREEMEN',.' <br /> Evergreen Environmental Services 90278 <br /> dedicated to the protection of the environment <br /> To schedule a pickup,call Send payment to: Sales Order �lo <br /> 800-972-5284 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark, CA EPA#CAD982413262 Dept.2457Ll <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles,CA 90084-2457 Da `e <br /> GEN TORMO LOCATION BILLI INFORMATION <br /> M ."�'.rJ ` r ....✓� NA --^'" CASH❑CHECK❑ <br /> ADIDRS <br /> [r ✓ ADDRESS / / ,) CUSTOMERCOD O.J <br /> S CITY /) STATE T,IP 9 PO ,r,.� <br /> P N O. �7 - ' PHONE NO. PROFILE NO. US MER EPA ID NO. <br /> — c 1 Y r <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 CA-221 Gal. <br /> Uwd Aulm,<ive AntiFrt Non-RCRA Hv Wws <br /> wwru ma CA134 Gal. <br /> RO WaAe CombucVblc lJquid,NO.S NA CAM <br /> 19d3111 Oil conuminetM wita bet FMIMM Gal. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Wade Solids and Sludges Gal. <br /> Wash Out Each Zia <br /> Drained Used Oil Filters Drum <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum <br /> Empty Drums Drum <br /> Transportation Hm <br /> Non Hazardous Water Gal. <br /> TEST:❑Clor D Tceh 4000____ppm ❑Clor D Tech 1000❑Pass Fail ❑ <br /> ❑ ❑ Halogen Detector/F'lame Test ❑Pass Fail <br /> Field Service Work Description. -Total Charges <br /> Other: <br /> Other / ) V <br /> Vacuum Services Time <br /> Out of Yard On Site Off Site Off Load Start Off Load End Return to Yard <br /> TSDF LJ Consolidated Manifest <br /> Evergreen Oil,Inc. Evergreen Env.Svc.. Evergreen Env.Svc. ❑ AJS Filter El <br /> Smith Ave. Road 30B 4193 N.Valentine 15131 Clark Ave.. <br /> Newark,CA 94560 Davis.CA 95926 Fresno.CA 93711 Industry,CA 91745 <br /> CADM80887418 CAD982446874 CAIN82446882 CAD000097432 <br /> ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ CFR CFR. 1:1Greenleaf Env.Svc. <br /> 16604 S San Pedro 745 A West Beheravia 94, E.Slauson Ave 33210 Western 3474 Toyon Circle <br /> Carson,CA 90746 Santa Maria,CA 93454 Los Angeles,CA 9 I I Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696420 CAD982446858 CAL000110021 CAL000091507 CAL000214411 <br /> Source: C3Collection Station El 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 <br /> bind the above listed fenerator to the terms on the reverse <br /> Reta' sample # side of this form. <br /> iiivet Sipnatur6 Prifit Name Route# Date Generator's Sianature Print Name Date <br />