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` WORK ORDEWSERVICE AGREEMENT <br /> Evergreen Environmental Services NO- 159740 <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: Sales Order# <br /> 800-972-5284 Evergreen Oil, Inc. <br /> 6860 Smith Ave.,Newark,CA EPA#CAD982413262 Dept, 2457 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles, CA 90084-2457 Date: <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NAME NAME CASH❑ CHECK❑ <br /> ADDRESS ADDRESS CUSTOMER CODE NO. <br /> CITY STATE, ZIP CO. CITY STATE ZH' CO. PO# <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Nan-RCRA Hazardous Lubricating CA221 Gal. <br /> Waste,Liquid Industrial CA221 Gat. <br /> Used Aummaive Ant ft,—,Nnn-RCR:i narard— CAt34 Gal. <br /> wmste Liquid _ <br /> RQ waste Cambustiblc Liquid,N.0 5.NA CA221 <br /> 1997 171 Oil s wrniamd wishhalo ens Fn611FO02 Gal. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> Wash Out Each <br /> Drained Used Oil Filters Drum <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum <br /> Empty Drums Drum <br /> Transportation Hrs. <br /> Non Hazardous Water Gal. <br /> TEST:❑ Clor D Tech 40tH) ppm ❑Clor D Tech IO00❑Pass ❑Fail ❑ Halogen Detector/Flame Test ❑Pass ❑ Fail <br /> Field Service Work Description: Total Charges <br /> Other: <br /> I <br /> Other: <br /> Vacuum Services Time <br /> Out of Yard On Site OFF Site-Off Off Load StartOff Load End Rcturn to Yard <br /> TSDF ❑ Consolidated Manifest <br /> ❑ Evergreen Oil.Inc. ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ A.IS Fi€ter <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine L� 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CADOOtX197432 <br /> ❑ Evergreen Env.Svc, Evergreen 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 90011 Union City.CA 94587 Valley Springs,CA 95352 <br /> CAD981696420 CAD982446858 CAL000110021 CAL00W91507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Ll Collection Station LJ Government &toxicity of the hazardous waste to the degree determined by <br /> ❑Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I herebyIcertify that I have read and have the authority to <br /> bind the above listed generator to the terms on the reverse <br /> Retain sample# side of this form. <br /> Driver Signature Print Name Route# Date Generator's Signature Print Name Date <br />