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WORK <br />vergreen Environmental Services <br />dedicated to the protection of the environment <br />To schedule arkpickup, call Send payment to:• <br />8®®®972-5284 Evergreen Oil, Inc. <br />mith Ave., Newark, CA EPA# CAD982413262 P.O. BOX 678252 <br />S. San Pedro St., Carson, CA EPA# CAD982413262 Dallas, TX 75267-8252 <br />,RATOR/JOB LOCATION BILLING INFO TI® <br />a l'n ` - — ✓ ® — NAME V.d ... , <br />CO. I CITY, <br />STATE <br />AGREEMENT <br />® 259857 <br />Sales Or <br />5e P# <br />Dat <br />CASH r- CHECK <br />N <br />PHONE NO. Imo.WO <br />PRODUCT <br />WASTE MANIFEST QUANTITY UNITS PRICE <br />CODE NUMBER <br />AMOUNT <br />Used oil, Non-RCRA Hazardous Lubricating CA221 <br />Gal. <br />Industry, CA 91745 <br />CAD000097432 <br />Waste, Liquid Industrial <br />CA221 <br />Gal. <br />Santa Maria, CA 93454 Los Angeles, C <br />CAD982446858 CAL00011002 <br />Used Automotive Antifrte , Non-RCRA H.—xbus <br />Waste Li aia <br />CA134 <br />Gal. <br />❑ Marine ❑ Agricultural ❑ Industrial <br />RQ Waste Combastible Liquid, N:O.S. NA <br />1993.1. Oilcontami,ated with halo •ens <br />CA221 <br />rrool/Foo2 <br />Gal. <br />I hereby certify that I have read and have the authority to <br />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />CA221 <br />Gal. <br />Waste Solids and Sludges <br />side of this <br />Gal <br />/ <br />en�tName <br />Wash Out <br />Driver 'gnature <br />Each <br />Generators lgnature Print Name Date <br />Drained Used Oil Filters <br />Drum <br />Non-RCRA Hazardous Waste Solids (oily debris) <br />CA223 <br />Drum <br />Empty Drums <br />Drum <br />Transportation <br />I -Ir s <br />Non Hazardous Water <br />Gal. <br />TEST: Ej Clor D Tech 4000 ppm ❑ Clor D Tech 1000 ❑ Pass Q Fail 0 Halogen Detector/Flame Test Pass Fail <br />Field Service Work Description: <br />Total ar es <br />Other: <br />Other: <br />Vacuum Services Time <br />Out of Yard On Site Off Site <br />TC1TTn <br />Off Load StartOff Load End <br />Return to Yard <br />1 OJJr <br />(_J Consolidated Manifest <br />Evergreen Oil, Inc. <br />6880 Smith Ave. <br />❑ Evergreen Env. Svc. ❑ Evergreen Env. Svc. <br />Road 30B 4139 N. Valentine <br />� AJS Filter ❑ <br />15131 Clark Ave. <br />Newark, CA 94560 <br />CAD980887418 <br />Davis, CA 95926 Fresno, CA 93711 <br />CAD982446874 CAD982446882 <br />Industry, CA 91745 <br />CAD000097432 <br />EEvergreen Env. Svc. <br />16604 S. San Pedro <br />❑ Evergreen Env. Svc. ❑ CFR CFR ❑ Greenleaf Env. Svc, <br />33210 Western <br />745 A West Betteravia 944 E. Slausoi46CAL000091507 <br />Carson, CA 90746 <br />CAD981696420 <br />Santa Maria, CA 93454 Los Angeles, C <br />CAD982446858 CAL00011002 <br />3474 Toyon Circle <br />Union City, CA 94587 Valley Springs, CA 95352 <br />Source: Ll Collection Station C3 Government <br />CAL000214411 <br />Generator certifies that it has established a program to reduce the volume or <br />❑ Marine ❑ Agricultural ❑ Industrial <br />quantity & toxicity of the hazardous waste to the degree determined by <br />generator to be economically practicable. <br />I hereby certify that I have read and have the authority to <br />Retain Sample # <br />bind the above listed generator to the terms on the reverse <br />side of this <br />/ <br />en�tName <br />/0� <br />Driver 'gnature <br />Route # Date <br />Generators lgnature Print Name Date <br />