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04/02/03 WED 21:20 FAX 209 957 3972 KINKO`S STOCKTON Z003 <br /> • J` WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services o <br /> ded icoted to the prolecliurt Ufa rhrr environment N_ 115 914 <br /> To schedule a pickup, call Send payment to. Sales Order /Iq�� ` 73 <br /> 800-972-5284 Evergreen Oa, Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 Depl. 2457 �J � � Z <br /> 1654.0 S.San Pedro$L,(>rgon,CA EPA#CAD98,'_41;i262 Los An�ele,. CA 90084-2457 Date: J �J <br /> #4 <br /> AS <br /> 4 <br /> (FIND RATOR/JOB LOCATION 13111 ING INFORMATION <br /> NAME �^` �/� NAME CASH C1 ECK <br /> A RISSAI)1)RP SS C'UST( MER C E NO- <br /> crry STATE ZIP CO. el'IN STATE ZIP CO. PO# <br /> < Gq 5rS 7.I_a <br /> ONE NO- _ PHONE NO. PROFILE,NO. CUSTOMER EPA M NO. <br /> PRODUCT WASTE NIANIFrST Q(IANTITY UNITS PRICE AMOUNT <br /> CODE Nj;M"",`BER <br /> Used oil,Nun-RCRA Hazardous _Luhricuting CAZ2] 2, iPJb Citi1, 7a <br /> Waste,Liquid Tndusn'lal CA2 1 Gul. <br /> u:cd nuanmoii-c Aniifiwv..N.—WRA Sl:wnuluua CA 134 -- Cy'al. - <br /> rsR N.oysrn.Nn <br /> 1NC,III Uil rnNam'unnrd will lvd, a P001/l'IM12, ,- _-, _ <br /> Oil£r Water.Non-RCRA Hmardous Waste Liquid CA221 — Ca1. ✓ <br /> Wnsrc Solids and Sludges _ Gal. -- <br /> wlI0)Out Hach <br /> Drained Used Oil Filret'c <br /> Non-RCRA A az:uduus Waste Solids(oily clehris) 0A2223 Drum <br /> Empty Drums _ - Drool --- <br /> Tt'tlnspnlYnlion --_ HIS, <br /> Non Ha%aC as Water Ciel. <br /> TEST Cl,,,-n Tech.10011-7,R—Oppm ❑CIOr 17 Tech (000 pass❑Fnil ❑ Halogen Dcteaodh'lame."fest ❑Pass ❑Pail <br /> Field Scrvice Work Descripaiun: _ Total Charges <br /> Other: --- <br /> Other. <br /> Vacuum Services Tillie <br /> out ul'Yard On Situ Off Sitc ...Off'Load Start Off Loal P.nd Return to Yard___ <br /> 7:.,,,.o <br /> _ . Consolidated Manifest _ <br /> r Sm Oil, Inc. Lvergrreen Env.Svc, F.vcrercen Pnv.Svc. A1S hitter <br /> 0 Smith Ave. ❑ Roud 306 ❑ 4L19 N.Valentine ❑ 15131 Clark Ave, ❑ <br /> Newark,CA 94,560 Davis,('A 95926 Fresno.CA 93711 Industry,CA 91745 <br /> C:AD980897418 CAD9S2446974 CAD982-1 M2 CAD000097432 -. <br /> ❑ Evergreen Env,Svc, ❑ FvcrprLen Lnv.Svc. ❑ CPR ❑ CFR ❑ Greenleaf Div.Svc. <br /> 16664 S.Sun Pedro J 745 A West Bel'teioviit Ll 94/1 Fd.Slauson Avc. 33210 Western —I 3474 Toynn Circle <br /> Carson,CA 90746 Santa Maria,CA 9:3454 Lus Angeles,CA 90011 Union City,CA 94597 Valley Springs.CA 95352 <br /> CAD981(,Y6420 CAu932446858 CA1..000110021 C.'ALM0091507 CAL0002 I z41 I I <br /> Gencmtor ccrtitics that it has established a program I(,reJuce.dicvnlnmc nr <br /> Source: ❑Collection Station ❑ Governnicrlt quantity&toxicity of the ha'rur IOLIN wost'c to rhe dcgrec determined by <br /> ❑Marine ❑ Agricultura.l ❑ Industrial 'rener,'Itor til he cc/mtnnicnll,y practicable. <br /> ---- I hereby certdV that I have read and have the atiithority-�-�, <br /> bind the aboyC listed generator to the terns on the re_ver_s_c <br /> It n sample # z side of this form. <br /> 03 <br /> ver Sipnat.urc Print Name Route!/ ate Gem aerator , ire Print. NaMC Date <br />