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• <br /> WORK ORDER/SERVICE AGREEMENT <br /> -;W' k Evergreen Environmental Services �o ?9 <br /> dedicared to the pmtectimt of the envirrmmenr <br /> To schedule a pickup, call Send payment to: Sales Order# <br /> 800-972-5284 Evergreen Oil,Im. <br /> 6880 Smith A",Newark,CA EPA#CA0982413262 P.O_ BOX 678252 <br /> 18540 S.San Pedro St,Carson,CA EPA#CAD9824132$2Dallas,TX 75267-8252 Date: <br /> GENER}ATORIJOB LOCATION BILLING INFORMATION <br /> NAM$ NAME CASH Q CHECK Q <br /> I DRESS # <br /> . A ESS CUSTOMER CODE NA - <br /> CITY STATT: 7 <br /> CITY STATE ZIP CO. 'PO# <br /> PHDIVE Nf1 PHONE NO• PROFILE NO. CUSTOMER EPA <br /> PRODUCT WAS MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Gaf <br /> Wry,Liquid Industrial CA221Gal. <br /> wv Ar�ar<Aaaft gt�3n.acnnxu.,,t,� CAt t <br /> RQ w.,ve 1.irCWa.N.Os.Vn CA.64 <br /> P5V}In wnwaiec'N vi6. Poutam4 <br /> Gat, <br /> Oil At Water,Non-RCRA Hazardwn Wavle Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Om - Each <br /> Drained Used on Filters k Dann <br /> NanIr <br /> -RCRA Hazardous Wade Solid,(oily debris) CAM r <br /> Drum <br /> En"DM= Dram I <br /> T—Wx4moa <br /> Nos Hazaidma Waff Gal. <br /> TEST:Q Cion D Tech 4p70_Pptn Q C1or D Tech 10000Pnes Q Fail Q.Halogen Dete=Mame Teat Q Pas., Q Fail <br /> Field Service Work Description: •. <br /> Total ChargeS <br /> Other: <br /> Oftr <br /> vacuum Services Time <br /> Out of.-fa-fad—on Site Off Site—Off Load Start Off Load Fad -Retum to Yard j <br /> TSDF Lj Consolidated Manifest <br /> ❑ 6687 So midtAl'I9c. ❑ Evergreen Env.Svc. ❑oB 4,Ve9r9 ErrvnSve. AIS Filter <br /> Newark,CA 94560 ❑ 15133 Clark Ave. ❑ , <br /> Davis CA 95926 Ptesno,CA 93711 Indastip,CA 91745 <br /> C.AD980897418 CAD982446974 CAD98244(M2 C.4D0(3(3097432 <br /> ❑ EVergreeat FmV.SVC. ❑ EYetgteen Ei1Y,SPC. ❑CFR . ' CFR Greenleaf Env.See- <br /> 944 S.Sas 1'tdro 74V;WA West 9enaavia 944 ti Sleoson Ave. ❑ 33230 West. ❑3474 Tovou Cycle <br /> Carson,CA 91Y746 Santa Maria,CA 93454 t.rB AweCA 9001f Union City,CA 94557 Valley Sprints,C.A.45352 <br /> CAD9816%420 CAD982446858 CAU10T11 icon CAL000091507 CAL!q(321441I ! <br /> G.eAetaxa cenAxx that it has evrablished a Program to reduce the votutme ar t <br /> Source: ❑Collection Station 0 Government yarn ty&toz c ty of the hazardous waste to the degree determined by <br /> ©Marine 0 Agricultural 0 Industrial generator m be economically praaicabl, <br /> I hereby certify that 1 have head and have the authority to <br /> Retain sample# bind the above listed gemmtor to the terms out the reverse <br /> sate of this fans <br /> Driver Signature Pun Name Route# Date Getters or,s Signature Print Name Date <br /> i <br /> i <br /> i <br /> t <br />