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M <br /> WORK ORDERJSERVICE AGREEMENT <br /> Evergreen Environmental Services No 247361 <br /> -.il� dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: Sales Or� <br /> 800-972-5284 Evergreen Oil, Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 P.O. BOX 678252 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Dallas,TX 75267-8252 Date" <br /> GENERAT_QJWJOB LOCATION BILLING INFORM ION <br /> NAMEi g - NAME CASH❑ CHECK❑ <br /> A14D Q� iCLrul�l�/ ADDRF / X 77jj/' CUR NO. <br /> 52 <br /> CIT Com, }STA�F�QCO. C < A IPO. <br /> (H O. (HONE NO. PROFILE NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UMTS 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 CA 134 Gal. <br /> Waste uid <br /> RQ Waste Liquid.quid N.O.S.NA F 01002 Gal. <br /> 1993 In Oil contaminated with halo ens <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> dL-/ l 30 D / <br /> Drained Used Oil Filters Drum <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Q Drum <br /> Empty Drums Drum ?�Q Q <br /> all <br /> Transportation Hrs. <br /> Non Hazardous Water Gal. <br /> TEST:❑ Clot D Tech 4000 ppm ❑Clor D Tech 1000❑Pass ❑Fail ❑ Halogen Detector/Flame Test ❑Pass ❑Fail <br /> Field Service Work Description: Ota flat es <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 ElConsolidated Manifest <br /> ❑ Evergreen Oil,Inc. ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ AJS Filter <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ CFRCFR f I r e c. <br /> 16604 S.San Pedro 745 A West Betteravia 944 E.Slauson Ave. 33210 Western LJ 3474 Toyon Circle <br /> Carson,CA 90746 Santa Maria,CA 93454 Los Angeles,CA 9 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 /> ❑Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authorityto <br /> bind the above listed generator to the terms on the reverse <br /> Retain sample # 71atoors <br /> is fm. <br /> Dri Signature nt ame Route# Date GSignature Print Name Date <br />