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WORK ORDER/SERVICE AGREEMENT <br /> Evergreen nvironmental Services N° 154150 <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: Sales Order � 40&48 <br /> 800-9 2-5284 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:—7 <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> ME , 4r NAME CASH❑ CHECK❑ <br /> 1141176 7- A I # <br /> ADZD-RESS w ADDRESS STO�R ODE NO. <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Used oil,Non-RCRA Hazardous 4ubricating CA221 7.4. CrC-> G.I. <br /> Waste,Liquid I idustrial CA221 Gal. <br /> Uud Automotive Antifmze.Non-RCRA HuArdous CA 134 Gal. <br /> wazle Ir uid <br /> RQ Wazte Combustible Liquid,N.O.S.NA CA221 Gal. <br /> 1993 tIl Oil tontaminated with halo ens F001/F002 <br /> Oil&Water,Non-RCRA Hazardous Wa to Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Drained Used Oil Filters Drum <br /> Non-RCRA HazardousWaste Solids(oil debris) CA223 Drum <br /> Empty Drums Drum <br /> Transportation Hrs. <br /> Non Hazar us Water Gal. <br /> TEST: Clor D Tech 4000AZO—Oppm ❑Clor D Tech 1000 ass ❑Fail ❑ Halogen Detector/Flame Test Pass ❑Fail <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum Services Time <br /> Out of Y d On Site Off Site Off Load Start Off Load End Return to Yard <br /> cno <br /> TS9t LA Consolidated Manif <br /> Evergreen Oil,Inc. ❑ Everg n Env.Svc. ❑ Evergreen Env.Svc. ❑ AJS Filter <br /> 6880 Smith Ave. Road 3 B 4139 N.Valentine 15131 Clark Ave. <br /> Newark,CA 94560 Davis, A 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980887418 CAD98 446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen Env.Svc ❑ Evergre n Env.Svc. ❑ CFR ❑ CFR ❑ Greenleaf Env.Svc. <br /> 16604 S.San Pe 745 A est Betteravia 944 E.Slauson Ave. 33210 Western 3474 Toyon Circle <br /> Carson,CA 90;46 Santa aria,CA.93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD98169 CAD98 446858 CAL000110021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Statin ❑ Government quantity&toxicity of the hazardous waste to the degree determined by <br /> Ll Marine LlAgr cultural 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 /> t in sample # side of this form. <br /> Z, <br /> Dr r Signature P"Fr'jnt'lqa ile Route# Date Generator's Signatu a Print Name Date <br />