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WORK ORDERS VICE AGREEMENT <br /> Evergreen Environmental Services No- 299606 <br /> dedicated to the protection of the environment <br /> wi To schedule a pickup, call Send payntclitto: Pffiqsader# <br /> 800-972-5284 Evergreen Oil, Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 P.O. BOX 678252 ud�Y <br /> ENVIR6tl '-U <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Dallas, TX 75267-8252HEA L TH DEIPM�,E"Q"'d <br /> GENERATOR/JOB LOCATION BILLING INFORMATION i�TMEN-r <br /> NAME CASH E-1 CHECK <br /> j M4A w& # !Tfn <br /> ADDRESS ADDRESS CUSTOMER CODE NO. <br /> C-�/C-Q cwir2fT�( <br /> CITY STATE ZIP CO. CITY STATE ZIP Co. PO# <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID N <br /> )C-?'RMIZZW I j:A40%�V77 0. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 127 <br /> Gal. ==o <br /> Waste, <br /> Waste,Liquid Industrial CA221 Gal. <br /> U Automotive Antifnwze,Non-RCRA Hazardous <br /> Waste <br /> Li uid <br /> CA 134 Gal. <br /> RQ Waste combustible==.N)A CA221 <br /> 1993 111(Oil coutarnina F001/F002 Gal. <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 <br /> Empty Drums Drum <br /> Transportation Hrs. <br /> Non Hazardous Water Gal. <br /> Glycol Bulk /50/50 Gal. <br /> Glycol Bulk/ Cone. Gal, <br /> TEST:LeClor D Tech 4000ppm 0 Clor D Tech 1000 Pass❑Fail E] Halogen Detector/Flame Test Vass 0 Fail <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum Se/ices Time <br /> to Yard <br /> Out of)�td-On Site-Off Site Off Load Start Off Load End Ret �2- <br /> E�'Consolidated Manifest k <br /> 7E <br /> Evergreen Oil,Inc. ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ AJS Filter ❑ <br /> 4139 N.Valentine 15131 Clark Ave. <br /> 6880 Smith Ave. Road 30B <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. F--] CFR ❑ CFR ❑ Greenleaf Env.Svc. <br /> 16604 S.San Pedro 745 A West Betteravia L-J 944 E.Slauson Ave. 33210 Western 3474 Toyon Circle <br /> Carson,CA 907AA Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD9816964K CAD982446858 CAL0001 10021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station J Government quantity&toxicity of the hazardous waste to the degree determined by <br /> Ll Marine ❑ Agricultural El Industrial generator to be economically practicable. <br /> I hereby certify that I_huve read and have the authority to <br /> bind the above listed generator to the terms on the reverse <br /> Re in sample # side of this form. <br /> ?; L 6, <br /> r Signature 01frint Name Route# Date /Gen Olto'r's Signature Prat Name Date <br />