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M <br />WORK ORDE&ERVICE AGREEMENT <br />een Environmental Services O 2634.02 <br />dedicated to the protection of the environment <br />.T_9schedule a pickup, call Send payment to: Sales Order # <br />; , 8®®'972'5284 Evergreen Oil, Inc. <br />Newark, CA EPA# CAD982413262 P.O. BOX 678252 " <br />dro St., Carson, CA EPA# CAD982413262 Dallas, TX 75267-8252 Date: <br />✓TOB LOCATION BILLING INFORMATION <br />NAME <br />ADDRESS <br />STATE ZIP CO. CITY STATE ZIP <br />P.: <br />PHONE NO. <br />PROFILE NO. <br />CASH ❑ CHECB ❑ <br />CO.*O <br />0,A -led <br />CUSTOMER EPA ID NO. <br />PRODUCT <br />WASTE <br />CODE <br />MANIFEST <br />NUMBER <br />QUANTITY <br />UNITS <br />PRICE <br />AMOUNT <br />Used oil, Non-RCRA Hazardous Lubricating <br />CA221a%: <br />Davis, CA 95926 Fresno, CA 93711 <br />Industry, CA 91745 <br />Gal. <br />CAD982446874 CAD982446882 <br />CAD000097432 �. <br />Waste, Liquid Industrial <br />CA221 <br />❑ CFR Greenleaf Env. Svc. <br />16604 S. San Pe <br />Gal. <br />I_J <br />33210 Western I_J 3474 Toyon Circle <br />Carson, CA 907A <br />Used Aotomm- Antifreeze: Non-RCRA Hazardous`CA1:34 <br />este Li uid <br />Union City, CA 94587 Valley Springs, CA 95352 <br />CAD9816964K <br />CAD982446858 CAL000110021 <br />Gal. <br />Source: Collection Station ❑Government <br />. <br />RQ Waste Combusfible Liquid N.O.S. NA <br />1993 In. Oil contaminated with halo <br />CA221 <br />F001/F002 <br />Gal. <br />LlMarine LlAgricultural LlIndustrial <br />- <br />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />CA221 <br />Gal. <br />Waste Solids and Sludges <br />R 1 # <br />�- - <br />Gal. <br />Wash Out <br />Each <br />Drained Used Oil Filters <br />Drum <br />Non-RCRA Hazardous Waste Solids (oily debris) <br />CA223 , <br />Drum <br />mpry Drums` <br />prom <br />Transportation <br />Hrs. <br />Non Hazaz us Water <br />Gal. <br />TEST: - Clor D Tech 4000 , Q pm ❑ Cl., D Tech 1000 <br />Pass ❑ Fail ❑ Halogen Detector/Flame Test ❑, <br />Pass ❑ Fail <br />Field Service Work Description: <br />Total Charges <br />Other: <br />Other: <br />Vacuum Services Time <br />Out of Yd On Site Off Site <br />Off Load Start Off Load End <br />Return to <br />Yard <br />TLS 16 <br />L` Consolidated Manifest <br />Evergreen Oil, Inc. <br />❑ Evergreen Env. Svc. ❑ Evergreen Env. Svc. <br />❑ AJS Filter ❑ <br />6880 Smith Ave. <br />Road 30B 4139 N. Valentine <br />15131 Clark Ave. <br />Newark, CA 94560 <br />Davis, CA 95926 Fresno, CA 93711 <br />Industry, CA 91745 <br />CAD980887418 <br />CAD982446874 CAD982446882 <br />CAD000097432 �. <br />❑Evergreen Env. Svc/ <br />❑ Evergreen Env. Svc. ❑ CFR <br />❑ CFR Greenleaf Env. Svc. <br />16604 S. San Pe <br />745 A West Betteravia 944 E. Slauson Ave. <br />I_J <br />33210 Western I_J 3474 Toyon Circle <br />Carson, CA 907A <br />Santa Maria, CA 93454 Los Angeles, CA 90011 <br />Union City, CA 94587 Valley Springs, CA 95352 <br />CAD9816964K <br />CAD982446858 CAL000110021 <br />CAL000091507 CAL000214411 <br />Source: Collection Station ❑Government <br />Generator certifies that it has established a program to reduce the volume or <br />quantity & toxicity of the hazardous waste to the degree determined by <br />LlMarine LlAgricultural LlIndustrial <br />generator to be economically practicable. <br />I hereby certify that I have read and have the authority io <br />bind the above listed generator to the terms on the reverse <br />R 1 # <br />�- - <br />U 1 SalllP a side of this form. : <br />1 -ver Signature Print Name Route # Date <br />