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WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services (t 170226 <br /> .iedk ared a>the protection of the enviranntrnt �f <br /> To schedule a pickup,call Send payment to: Sales Order# 6 [ - &a7 <br /> 800-972-5284 Evergreen oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 P.O. BOX 678252 <br /> 16540 S. Sen Pedro Sr.,Cetaen, CA EPA#CAD982413262 Dallas,TX 75267-8252 - Date: 2_4`9-0 <br /> ENERATORIJOB LOCATION BILLING INFO TION <br /> 1E 1NAME <br /> 1'fCASH Q CHECK <br /> ADDRE ADDRESS # <br /> /1A D�DEyo. <br /> TA4 ' ZI Co. CITY STATE ZIP CO. PO# <br /> 0 ' N PHONE NO. PROFILE NO. U C Tib <br /> -3� c > a <br /> PRODUCT WASTE MANIFEST <br /> QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA'22l Gal, <br /> Waste,Liquid Industrial CA221 Gal. <br /> I <br /> ,tt. wu s...a,wtrr..c wm.Rcw%11 .1 u CAI34 Gal. <br /> RQ 11 m - R.;, , .osNA <br /> rwm o „ CAit <br /> 1`001 u2 Gal. <br /> Oil& Water.Non-RCRA Hazardous Wane Liquid CAI-21 Gal. <br /> Waste Solids and Sludges GaL <br /> Wall Out ,Each <br /> Drained Used Oil Filters fyrnm <br /> Non-RCR4 Hazardous Waste Solids(oily debris) CA223 Drnn1 <br /> Empty Drmus Drum <br /> Transportation <br /> Hrs. <br /> Non Hazardous Water ..Gal <br /> TEST:'Cior D Tech 4000_pped ❑Clrr D Tech IOW E]Pass❑Fail Q Halogen DetectonFlune Test ❑Pass EjFail y� <br /> Field Service Work Description: Total Charges <br /> Other. <br /> Vacuum Services Time (1(f <br /> Out of Y lu Ge Silt Off Site_Off Load SM-Off Lead End Retum bin Yard <br /> TSDF Consolidated Manifest <br /> Eve6880 Smith Ave.een Oil,brc70 RoaEved 30B etarEnv.Svc ❑4139 N.Valentines ❑ 15 31 Fiber <br /> Ave. <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 ludustry,CA 91745 <br /> CAD980887418 C.AD982446874 CAD982446992 CAD000097432 <br /> Ek Enc.S . Evergreen Env.Svc. ❑CFR ❑ CFR ❑ Greenleaf Env.Svc. <br /> iun 66Ci4 S.SPedro a 745 A West Beneraviu 944 E.Slausoa Ave. 33210 Western 3474 Toyou Circle <br /> Caron,CA 90746 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley, nnggs,CA 95352 <br /> CAD981696420 CAD982446958 CALOOOII0021 C.AL0p0091507 CA1 1, <br /> $OUFCe: collection Station Q Government Generator certihm that it has established a program to reducu the volunre or <br /> quantity&toxicity of the hazardous waste to the degree determined by <br /> J Marine ❑ Agricultural D 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 on the reverse <br /> Retain sample # site of this form. <br /> z _0 <br /> Driver Sig1 ture t Name Route# Date Generator's Signature Print Name Date / <br /> 4 DC7 <br />