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12/16/03 17:25 NORTP^X FRENCH CAMP 4 2094683433 NO.214 913 <br /> I I <br /> I <br /> WORK ORDER/SERVICE AGREEMENT � <br /> Evergreen Environmental Services No 151190 <br /> -�+ dedicat to the protection of thr eptAivnment <br /> To scheule a pickup, call Send payment to: Sales Order# <br /> 800 72-5284 Evergreen Oil,Inc. <br /> 6880 Smith Avo„Newark CA Ad CAD982413262 DepL, 2457 <br /> 16540 S.San Fadto St,Carson,CA EPA#CA)982413282 Los Angeles,CA 90084-2457 Date: <br /> (;MRATORIJOB LOC TION BILLING INFORMATION <br /> NAME CASH Q CHECK <br /> �DbjtEbg ADDRESS CUSTOMER CODE NO. <br /> I STA TE ze CO. CITY STATE zw CO. <br /> 15-43 1;WONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA 11)NO. <br /> '^-%IZ'L ( ) <br /> PRODUCT WASTE MANWEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Uscd oil,Non-itCR,A Hazardous Lubricating CA221 Gal. <br /> Wasm,Liquid Industrial CA221 Gal. <br /> U.d AoromO A-fi—.r—RcnA x. � CAI,34 Gal. <br /> ..c a <br /> R4 waic Qmbuu37c i.:,+.:C x.C.S.NA CA221 <br /> tea m a,*,tea r1m n�1 " FD01/F0o2 <br /> Oil&Water,Non-RCRA Htazatdot s'Wastc Liquid CA221 Gal, <br /> Waste Solids and Sludges Gal. <br /> push Out Each <br /> Drained Used Oil Filters Dann <br /> Non-RCRA Hazardous rite Soli (oily debris) CA223 Drum <br /> Empty Drums Dnun <br /> lrra¢rsportatio Mrs. <br /> Non H w Water Gal. <br /> TUT-46 Clor D Tech 4 ppm ❑Clor D Tech 1000 Pass [�Fail ❑Halogen DetectorlFlame Test ass E]Nil r <br /> Field Service Work Description: Total Char eS <br /> � 4dtcr <br /> �tlicr <br /> Vacuum Se s Time <br /> but of Y d On Site cuff Site Off Load Stad Off Load End Re 1m to Yard <br /> TS Consolidated Manifest <br /> Evergreen Oil,Inc. � vcrgtccn Env.Svc. ❑Evei,rceen Env,Svc. I—I AJS Filmy T <br /> 6880 Smith Ave. cad 30D 4139 N.Valentine U 15131 Clark Ave U <br /> Newarlt,CA 94560 avis,CA 95926 Fresno,CA 93711 lndusttyy:CA 91745 <br /> l CAD93088/.4" AD982446814 CAD992446882 CAD000097432 <br /> I EvcTgran U verFrcen Cnv.Svc. CFR CFR Geeuleaf Grv,Svc, <br /> 16604S.SJ 7 5 A West Reneravia 944 E Slauson Ave 33210 Western 3474 Toyon Circe <br /> Carson,CAS nta Matra,CA 93454 Los An eles,CA 90011 Union Ciryry CA 94587 Vallcy S rinbc�,C.A 95352 <br /> AD98169AD982446858 CAL000110021 CAL000091507 CAL 0021 1I <br /> =crumr certifies tlwc it has established a program to reduce the volume or <br /> Source: Collection tation Government quantity&toxicity of the hazardous waste to the degree determined by <br /> 0 14v�ilrlIle Q P►atic'ultural Industrial generator to be economically practicable, <br /> t I hereby certify- that I have read and have the authority to <br /> bind the above listed generator to the ternis on the reverse <br /> R in sample # side or this roan. <br /> 0,; <br /> e Dri Signature Pri t Name Douce# Date aerator's Signature Print Name Date <br /> P <br /> i <br />