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WORK ORDER/SERVICE AGREEMENT Evergreen Environmental Services No 215260 dedicated to the protection of the environment - To schedule a pickup, call 800-972-5284 6880 Smith Ave., Newark, CA EPA# CAD982413262 16540 S. San Pedro St., Carson, CA EPA# CAD982413262 91FNF.R`ATnR/IOR f.00ATION Send payment to: Evergreen Oil, Inc. P.O. BOX 678252 Dallas, TX 75267-8252 RIT.LfNG INFORMATION Sales Order # Date: NAME -- NAME AMOUNT CASH ❑ CHECK ❑ CA221. Gal Fresno, CA 93711 Waste, Liquid industrial CA221 ADDRESS' - ADDRESS CA 134 .CUSTOMER COBENO. CITY STATE ZIP-- CO. CITY STATE ZIP CO. PQ -7 f- PHONE NO.. (�, -- PHONE NO. Source: Ll Collection Station ❑ Government PROFILE NO. CUSTOMER EPA ED NO.. Gal. ,; Wash Out ' Each . PRODUCT WASTE MANIFEST QUANTITY CODE NUMBER UNITS PRICE AMOUNT Used oil, Non-RCRA Hazardous Lubricating CA221. Gal Fresno, CA 93711 Waste, Liquid industrial CA221 Gal. „CAD000097432 U Wancu maxa nmoawaoc Amamao, Nan-RcaA xazadan CA 134 Gal, 16604 S. San Perlin A West Betteravia RQ Warn Combu iTle ❑quid. N.O.S. NA iN3 m rod oonmmioaxd win tat CAM] FOOIN 02: Gal Los Angeles, CA 90011 Union City, CA 94587 Valley Springs, CA 95352 Oil & Water, Non-RCRA Hazardous Waste Liquid CA221 Gal. Source: Ll Collection Station ❑ Government Waste Solids and Sludges Generator certifies that it has established a program to reduce the volume or quantity & toxicity of the hazardous waste to the degree determined by Gal. ❑ Industrial Wash Out ' Each . Drained Used Oil Filters I hereby certify that I have read and have the authority to Drum J '' Non-RCRA Hazardous- Waste Solids (oily debris}, CA223 z Drum side of this form. Empty Drums !� - E-! ._ i Drum Driver Signature Print l4ame Transportation _- Hos. Non Hazardous Water Gal. TEST: ❑ Clor D Tech 4000—ppm ❑ Clor D Tech 1000 ❑ Pass ❑ Fail ❑ Halogen Detector/Flame Test ❑ Pass ❑ Fail Field Service Work Description: Total Charges Other: Other: Vacuum Services Time Out of Yi nl On Site Off Site Off Load Start - Off Load End Return to Yard TSDF U Consolidated Manifest ❑Evergreen Oil, Inc. Evergreen Env. Svc. El Evergreen Env. Svc. AIS Filter 6880 Smith Ave. Road 30B 4139 N. Valentine 15131 Clark. Ave. Newark, CA 94560 Davis, CA 95926 Fresno, CA 93711 Industry, CA 91745 CAD980897418 CAD982446874 CAD982446882 „CAD000097432 ❑Evergreen Env. Svc. Evergreen Env. Svc. CFR" CFR Greenleaf Env. Svc. � 16604 S. San Perlin A West Betteravia 944 E. Slauson Avd. 33210 Western 3474 Toyon Circle - Carson, CA 90746 Santa Maria; CA 93454 Los Angeles, CA 90011 Union City, CA 94587 Valley Springs, CA 95352 CAD981696420 CAD982446958 CAL000110021 CAL000091507 CAL000214411 Source: Ll Collection Station ❑ Government Generator certifies that it has established a program to reduce the volume or quantity & toxicity of the hazardous waste to the degree determined by ❑ Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. I hereby certify that I have read and have the authority to bind the above fisted generator to the terms on the reverse Retain sample # side of this form. Route # Date Generator's Signature Print Name Date Driver Signature Print l4ame