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seen Environmental Services <br />dedicated to the protection of the environment <br />To schedule a pickup, call Send payment to: <br />80®-972-5284 Evergreen Oil, Inc. <br />e„ Newark, CA EPA# CAD982413262 P.O. BOX 678252 <br />Pedro St., Carson, CA EPA# CAD982413262 Dallas, TX 75267-8252 <br />)R/JOB LOCATION BILLING INFORMATION <br />PRODUCT <br />WASTE <br />CODE <br />MANIFEST QUANTITY UNITS PRICE AMOUNT <br />NUMBER <br />Used oil, Non-RCRA Hazardous Lubricating <br />CA221 <br />Gal. <br />Waste, Liquid Industrial <br />CA221 <br />Gal. <br />Used Automotive Antifreeze. Non-RCRA Hazardous <br />Waste Li uid <br />CA 134 <br />Gal. <br />RQ Waste Combustible Liquid, N.OS. NA <br />1993 m Oil contaminated with halo ens <br />CA221 <br />F001/F002 <br />Gal <br />Oil & Water, Non-RCRA Hazardous Waste Liquid <br />CA221 <br />Gal. <br />Waste Solids and Sludges <br />Gal. <br />Wash Out <br />Each <br />Drained Used Oil Filters <br />D <br />�,l115 <br />Non-RCRA Hazardous Waste Solids (oily dpris) <br />CX223D <br />:mpty Drums Drum X <br />Transportation s.' <br />Non Hazardous Water al. <br />Glycol Bulk 50/50 al. <br />Glycol Bulk Conc. al <br />TEST: ❑ Clor D Tech 4000 ppm ❑ Clor D Tech 1000 ❑ Pass ❑ Fail ❑ Halogen Detec /Flame est ❑ s ❑ Fail <br />Field Service Work Description: Total Charges <br />Other: <br />Other: <br />Vacuum Services Time <br />Out of Yard On Site Off Site Off Load StartOff Load End Return to Yard <br />TSDF ❑ Consolidated 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 95616 Fresno, CA 93722 Industry; CA 91745 <br />CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br />❑Evergreen Env. Svc.1:1Evergreen Env. Svc. ❑ CFR CFR ❑ Greenleaf Env. Svc. <br />16604 S. San Pedro 745 A West Betteravia 944 E. Slauson Ave. 33210 Western 3474 Toyon Circle <br />Carson, CA 90746 Santa Maria, CA 93454 Los Angeles, CA 9 1l 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 authority to <br />bind the above listed generator to the terms o the rever <br />Retain sample # side o72� <br />7 <br />Driver Signat e Prin e Route '# Date Generator's Signature Print ame Date <br />a <br />