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WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services N° 157960 <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: Sales Order,!�67 5_9 <br /> 800-972-5284 Evergreen Oil, Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Dept. 2457 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles, CA 90084-2457 Date <br /> GEN ATO B LOCATION e BILLING INFORNUTION <br /> N / lJ NAME CASH ❑ CHECK❑ <br /> # <br /> ADD SE ADDRESS O R O <br /> Z ne <br /> CITY STATE A ZIP O. CITY STATE ZIP CO. PO# <br /> NO. ROFILE NO. <br /> ( ) PN(HON N . PHONE N . <br /> d <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Automaive Antifreeze,Non-RCRA Hazardous CA 134 Gal. <br /> Waste Li uid <br /> Ito Waste Combustible Liquid,N.O.S.NA CA221 Gal. <br /> 1993 111 Oil contaminated with halo ens F001/F002 <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 O <br /> Empty Drums Drum <br /> Transportation Hrs. <br /> Non Hazardous Water Gal. <br /> TEST:❑ Clor D Tech 4000 ppm ❑Clor D Tech 1000❑Pass ❑Fail ❑ Halogen Detector/Fiame Test ❑Pass ❑Fail 7,750 <br /> Field Service Work Description: l ulal C ll:u" <br /> Other. <br /> Other: <br /> Vacuum Services Time <br /> Out of Yard On Site Off Site Off Load Start Off Load End Return to Yard <br /> TSDF 0 Consolidated ManifestWSvc. <br /> Evergreen Oil,Inc. Evergreen Env.Svc. Evergreen Env.Svc. AJS Filter 'L�6880 Smith Ave. ❑ Road 30B ❑ 4139 N.Valentine 15131 Clark Ave.Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ CFR CFR Gr <br /> 16604 S.San Pedro 745 A.West Betteravia' 944 E.Slauson Ave. 33210 Western 3474 Toyon Circle <br /> Carson,CA 90746 Santa Maria,CA 93454 Los Angeles,CA 90011 Union Ciry,CA 94587 Vail Springgs,CA 95352 <br /> CAD981696420 CAD982446858 CAL000110021 CAL000091507 CAL0002144I1 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: ❑ Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑ Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I 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 -,nmvdp # side of this form. <br /> Drive/_C1 Aure Ffirif Name Route# Date Generator' Signature Print Name D to <br />