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WORK ORDER/SEVICE AGRWEX005 <br /> Evergreen Environmental Serviceso P- i;ItALf . <br /> dedicated to the protection of the environment .. ^~ <br /> To schedule apickupA#, call Send payment to: Sale d/ <br /> 800-972-5284 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CADa82413262 P.O. BOX 678252 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Dallas,TX 75 7-8252 Date^� <br /> GENER <br /> ATO9/JjO0 JOCATIW BILLING INFORMATION <br /> NAM NAME CAS C EC <br /> DRE ADD U TF.JRVE N <br /> t a <br /> I TATE IP CO. CITY STATE ZIP CO. P # <br /> Z <br /> PHON NO PHONE NO. PROFILE NO. CUS OM <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 Automotive Antifreeze,Non-RCRA Hazardous CA134 Gal. <br /> Waste Lino <br /> RQ Waste Combustible Liquid N.O.S.NA CA221 Gal. <br /> 1993 In Oil contaminated with halogens) F001/F002 <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each Ile <br /> Drained Used Oil Filters AAA Drum <br /> Non-RCRA Hazardous W to ids y d CA• 23 Drum <br /> Empty Drums Drum <br /> JF <br /> Transportation Hrs. <br /> Non Hazardous War Gal. <br /> Glycol Bulk 0 Gal. <br /> Glycol Bulk b6c. Gal. <br /> TEST:❑ Clor D Tech 4000 ppm ❑Clor D Tech 1000❑Pass❑Fail ❑ Halogen Detector/Flame Test ❑Pass ❑Fail <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum Services Time a <br /> Out of Yard On Site Off Site Off Load Start Off Load End--Return to Yard <br /> TSDF ❑ Consolidated Manifest <br /> ❑ Evergreen Oil,Inc. ElEvergreen Env.Svc. FJ4139 <br /> Env.Svc. ❑ AJS Filter ❑ <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen`Env.Svc. Evergreen Env.Svc. ❑ CFR CFR ❑ Greenleaf Env.Svc. <br /> 16604 S.San Pedro 745 A West Betteravia 944 E.Slauson 33210 Western 3474 Toyon Circle <br /> Carson,CA 90746 Santa Maria,CA 93454 Los Angeles,C 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696420 CAD982446858 CAL000110021 CAL000091507 CAL000214411 <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 /> Ll Marine ❑ Agricultural L) 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 Sample # q side of this form. <br /> Driver Signa re nt Name Route# Date nerator's Signature I Pri ame Date <br />