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I <br /> 1 <br /> WORK ORDER/SERVICE AGREEMENT <br /> Evergreen En*ironff ental Services W 159675 <br /> dedicated to the Ip' rotection n the environment //o <br /> To schedule a k:kup, call Send payment to: Sales Orde9+r —L-[---� <br /> 800-97215284 Fvergreen Oil, Inc. <br /> seen Smith Avis-Newark,CA EPA#CAOM413282 Dept. 2457 v <br /> 18540 S.Sen PWM St.,Cari CA EPY CADM41 Lis Angeles,CA 90084-2457 Dat/ ��' / <br /> GF-N TOR/J0 LOCATIO BILLING INFO ON <br /> NA NAME CASH Q CHECK[] <br /> x <br /> ADDRESS <br /> C - [P CO. CITY STATE ZIP Co. # <br /> �PA O PHONE NO. HIPROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT <br /> W E MANIFEST <br /> C E NUMBER QUANTITY UNITS PRICEAMOUNT <br /> '`Used oil,Non-RCRA Hazardous ricating C 221 Gal. -- <br /> I Wvcte,L"uryid _ In suial C 221 Gal.- — <br /> ua.a�umnw�•x n.oxeu.au.aca�x..aaeaa C 134Gal. <br /> Wer _ — <br /> 49 Wane Cnnlwaaae IAquM, <br /> NO s a) _ bsFoo2 Gal. <br /> 199]Ills x, ' a' r <br /> Oil A Water.Non"RCRA Hazardews West Liquid . d 221 Gal. <br /> Waste Solids and Sludges --_ _ Gal. <br /> Wash Out Each <br /> Drained Used Oil Filters — Drum — <br /> Non-RCRA Hazardous Waste Solids(oily ebnsr k223 Dn+m <br /> Empty Dn ats Drum _ <br /> Tmnsportatitm _ Hes. <br /> I Non Hazardous Water .---�' Gil. <br /> TEST;❑ Clor D Toch 4U81)_ppu 6G C4x D T h IIXq CI Pass❑Fail Q Halogen DeteclurlRarne Test ❑Pus ❑Fail <br /> Field Service Work Description: _ µ_ __ Total C11ilr 05 <br /> Other: y I _ <br /> (hher: . <br /> Vacuum Services Time == -_ <br /> Out of Yard—(he Site ()if Site--4 Oft Load Start—_�00'load F.rld__Reto Pard__— <br /> ISDF Consolidated Manifest <br /> ��-Jl Evergreen Oil.Jrs 1 Eve a Env. Svc. r� Ewrgrecr.Env.Svc. n AJS Filter <br /> t-1 6880 Smith Av'e. L R B ' u 4139 N.Valentine 0 15131 Clark Ave. <br /> Newark,CA 94564) Davis. A 95926 Fresno,CA 93711 Industry,CA 91745 _ <br /> CAD9F0887419 CAD982446974 CAD98244h982 CACNXi XYJ74Q <br /> �l Evrrcrven Env Svc, r Evergr en Ent Svc r, CFR CFR 1 Greenleaf Env. Svc. <br /> 166114 3.San Pedro 745 Aa�1'est Benera L—% 944 E.Slauwn A 33210 Western LJ 3i7: royon Circle <br /> Carson,CA 90746 Sana tllana,CA 934 Les Anggeles. 9d)l Union Cityy,CA 94587 Valleyy Sppnnnggs.C4 9515: <br /> CAD98I61,6420 CAD91t2446858 _ C'.AI.000110(r21 CAL(a)Olr)1107 CALAfa)214411 <br /> Generator certifies that it has established a prulpm to reduce the volume,nr <br /> Source: 0 Collection Station i.7 vernment quantity&witicity of the hazard ws waste to the degree determined by <br /> Manne J Agficultural Industrial I generator to be ecunumically pracuuble. <br /> -- -----' I hereby certify that I have read and have the authREj W <br /> bind the above listed generator to the terns on the reverse <br /> Retain camp --- ---___—� side veva this tette. <br /> -- <br /> -- - <br /> Driver gnature nt Ntme oute# Date Generator's Signature Prin7Nanie Date <br />