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Apr 19 04 01 : 15p I- 3mer, s 4GP-915 p, l <br /> i <br /> Ji <br /> t WORK ORDER/SERVICE AGREEMENT <br /> A <br /> Evergreen nvlronmentai Services NO- 187555 <br /> lv dedicated 11 11tr protection of the rnrironnieul Q <br /> To schedul a pickup, call Send payment to: Sales Order <br /> 800-9 2-5284 Evergreen Oil, Inc- <br /> 6880 Smfth Ave.,Newark,CA EP CA0982413262 P.U. BOX 678252 <br /> 16540 S.San Pedro St.,Carson,CP EPA#CAD982413262 Dallas,TX 75267-8252 Date: <br /> GENERATORIJOB LOCAT ONMILLING INFORMATION <br /> NAMF, <br /> _ NAME, CASH❑CHECK <br /> ADDRESS ADDRESS OUST R C ENO. <br /> C[T ' <br /> STATI ZIP CO. CITY STATE ZIP CO. PO# <br /> "'f� PIa to <br /> PHONENO. Cf7 PHONE.NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> 235702E <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 55k11eqZO Gal. <br /> Waste,Liquid Industrial CA221 Gal, <br /> Usa Am—dAi,v A,,IA ea.Non RCRA 11owdw. CA 134 Z Gal. sIp <br /> Wuate I.i uid <br /> kQ Wash ComLusdi'k t.iyuid.N.O.S.NA CA221 Gal. <br /> 14)3 al Uil.,nlwnivaivJ whh halo•-. 1'1x1 I/I:ea2 _....-- <br /> Oil&Water.Non-RCRA Hazvdous N laste 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( ily debris) CA223 Drum <br /> Empty Drums Drum <br /> Tnrnspoltatiol Hrs. <br /> Non Hazai )us Water Gal. <br /> TEST:11Clor D Tech 400Q±A._p m ❑Clor D Tech IOW ass❑Fail ❑ Halogen Detector/Flame Test U Pass ❑Fail Z <br /> Field Service Work Description: Total Charges <br /> Other: A 3 ®® <br /> Other: ] <br /> Vacuum rvices Time <br /> K"130B <br /> Off Site_ Oft Lead Stan -.—011Load End Return to YardConsolidated Manifest <br /> egreen Env.Svc. ❑ Evergreen fine.Svc. ❑ A1S Filteroa 30B 4139 N.Valentine 15131 Clark Ave. -- -- <br /> Newark,CA 94560 Days,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980887418 CA 82446874 CAD982440882 CADW0097432 <br /> ❑ Evergreen Env.S c. ❑ Eve greets Env.Svc. ❑CFR ❑ CFR ❑ Greenleaf Env.Svc. <br /> 16604 S.San P ro 745 West Reta ravia 944 E.5lauson Ave +3210 Western 3474 Toyon Chrle <br /> Carson,CA 46 San Maria,CA 93454 Los Angeles,CA 9W I Union Citv,CA 94587 Valley Springs,CA 95352 <br /> CAD98I69 U CA 982446858 CAL000110021 CALO(M§1507 CAL00(1214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: lCollection St Iiot1 ❑Government quantity cC toxicity of the hazardous waste to the degree detemined by <br /> ❑Marine U grICultural C] Industrial generator Lu be muuumically practicable. <br /> I hereby certify that I have read and have the authority to <br /> bind the above Listed aeneri►tor to the terms on the reverse <br /> Re n sample # side of this form. <br /> D er Signature Print ame Route# Date 4n -'s Signature Print Name Date <br />