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WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services $9041 <br /> VIP dedicated to the protection of the environment <br /> To schedule a pickup,call Send payment to: Sales Order Al <br /> 800-972-5284 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark, CA EPA#CADM413262 Dept 2457 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Lob Angeles,CA 90084-2457 Date' ��T s r <br /> CENERATORIJOB LOCATION BILLING INFORMATION <br /> NAME NAME CASH❑CHECK❑ <br /> r <br /> AD SS f ADDRESS CuS]FDMER CODE NO. <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> P O ENO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> i <br /> j PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil Non-RCRA Hazardous Lubricating CA 221 > t J T - »'Z) Gal. 5y. ,r4 <br /> Waste,Liquid Industrial CA221 Gal. <br /> Uel A,aaoarive A�fa Nm-RCRA H r s <br /> W..U 'd CA 134 Gal. <br /> RQ WeRC b=1.1 1A d..N.O&NA QAr]� Gal. <br /> Ives ra "canoml�ar. �.,uw . raoumoz <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Wade 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 4000L—�jppm ❑Clor DTech 1000 PkPass❑Fail ❑ Halogen Detector/Flame Test ❑Pairs ❑Fail <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum Services Time <br /> t <br /> j Out of Yard On Site Off Site Off Load Stan Off Load End Return to Yard <br /> TSDF Consolidated Manifest <br /> I Evergreen Oil,Inc. F-1 Evergreen Env.Svc.. � Evergreen Env.Svc. AIS Filter <br /> LLJJ 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 /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> Evergreen Env.Svc. F-1 Evergreen Em.Svc. � CFR CFR. ❑ Greenleaf Env.Svc. <br /> 16604 S.San Pedro 745 A West Beteravia 944 E.Slauson Ave. 33210 Western 3474 Toyon Circle <br /> Carson,CA 90746 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696420 CAD992446858 CAL000110021 CAL000091507 CAL000214411 <br /> Generator cenifies that it has established a program to reduce the volume or <br /> Source: ®`Collection Station ❑Government I quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑ I generator to be economically practicable. <br /> Marine El Agricultural [3 Industrial <br /> 1 hereby certify that 1 have read and have the authority to <br /> y bind the above listed generator to the terms on the revers <br /> i e <br /> Retain sample # side of this form. <br /> I <br /> Driver Signature Print Name . Route# ate Generators Signature Print Name Date <br />