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d 4 WORK ORDER/SERVICE AGREEMENT Evergreen Environmental Sevi s NO- 155810 dedicated to the protection of the environment To schedule a pickup, call Send payment to: Sales Order # % b? W 800-972-5284 Evergreen Oil, Inc. 6880 Smith Ave., Newark, CA EPA# CAD982413262 Dept. 2457 16540 S. San Pedro St., Carson, CA EPA# CAD982413262 Los Angeles, CA 90054-2457 Date: d`_VrZVDATn tInR I.nCATInN BILLING INFORMATION PRODUCT WASTE MANIFEST QUANTITY UNITS CASHE] CHECK ADDRESS r CAD000097432 CODE NUMBER CU;SVER CODE NO.' CAD98169 _0 CAD982446858 CAL000110021 CAL000091507 CAL000214411 Generator certifies that it has established a program to reduce the volume or Used oil, Non-RCRA Hazardous Lubricating CA221 -Z_"f p Gal. CI ly STATE CITY STATE ZIP co. side of this form. 'HONE NO. PHONE NO. Used Automotive Anuft—, Non-RCRA Hazardous Waste Liquid PROFILE NO. CUSTOMER EPA ID NO. PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT CAD000097432 CODE NUMBER 16604 S. San P [to 745 A West Betteravia 944 E. Slauson Ave. Carson, CA 9 i46 Santa Maria, CA 93454 Los Angeles, CA 90011 Union City, CA 94587 Valley Springs, CA 95352 CAD98169 _0 CAD982446858 CAL000110021 CAL000091507 CAL000214411 Generator certifies that it has established a program to reduce the volume or Used oil, Non-RCRA Hazardous Lubricating CA221 -Z_"f p Gal. Waste, Liquid Industrial CA221 side of this form. Gal. Signature rint Name Route # D to enera is Sign t re Print Name Date Used Automotive Anuft—, Non-RCRA Hazardous Waste Liquid CA 134 Gal, RQ Waste Combustible Liquid, N.O.S. NA 1993 Iii (Oil contaminated with halogens) CA221 FW I/F002 Gal. Oil & Water, Non-RCRA Hazardous Waste Liquid CA221 Gal. Waste Solids and Sludges Gal. Wash Out Each Drained Used Oil Filters Drum Non-RCRA Hazardous aste Solids (oily debris] CA223 Drum Empty Drums Drum Transportation mss. Non Hazar s Water Gal. TEST: Clor D Tech 4000 pm❑ Clor D Tech 1000 Pass ❑ Fail ❑ Halogen Detector/Flame Test Pass ❑Fail Total Char es Field Service Work Description: Other: Other: Vacuum Servi s Time Off Load End Retu Yard / Out of Yar On Site Off Site Off Load Start TS o❑ C:onsoli atesl ivla itest Evergreen Oil, Inc. Evergreen Env. Svc. Evergreen Env. Svc. ❑ AJS Filter ❑ 15131 Clark Ave. 6880 Smith Ave. Road 30B 4139 N. Valentine Newark. CA 94560 Davis, CA 95926 Fresno, CA 93711 Industry. CA 91745 CAD980887418 CAD982446874 CAD9824-46882 CAD000097432 ❑Evergreen Env. c. ❑ Evergreen Env. Svc. ❑ CFR ❑ CFR ❑ Greenleaf Env. Svc. 33210 Western 3474 Toyon Circle 16604 S. San P [to 745 A West Betteravia 944 E. Slauson Ave. Carson, CA 9 i46 Santa Maria, CA 93454 Los Angeles, CA 90011 Union City, CA 94587 Valley Springs, CA 95352 CAD98169 _0 CAD982446858 CAL000110021 CAL000091507 CAL000214411 Generator certifies that it has established a program to reduce the volume or SOU e: J Collection Station ❑ Government � quantity & toxicity of the hazardous waste to the degree determined by ❑ Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. I hereby certify that I have read and have the authority to bind the above listed generator to the terms on the reverse 1) sample �� r G" side of this form. tDe Signature rint Name Route # D to enera is Sign t re Print Name Date