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J <br /> • \WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Ser4es N° 168381 <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 /> 6880 Smith Ave., Newark,CA EPA#CAD982413262 P.O. BOX 678252 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Dallas, TX 75267-8252 Date: <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NAME NAME CASH ❑ CHECK❑ <br /> # <br /> ADDRESS ADDRESS - CUSTOMER CODE NO. <br /> l -TLQ'= Z <br /> CI , STATE ZIP - CO. CITY STATE ZIP CO. PO# <br /> 5i'sG9T49P <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER p <br /> Used oil.Non-RCRA Hazardous Lubricating CA221 �OI,f/ uQ Gal. 2 S Z'y <br /> Waste, Liquid Industrial CA221 Gal. <br /> Uwd Auwmmive Antitmcw,Non-RCRA Hamel CA13d - Gal. <br /> Wave Li uid <br /> r%–. .— <br /> RQ W asm Comhrlible Liquid N.O.S.NA CA221 Gal. <br /> 1991 III(Oil conuminamd wNN halogens) ftXnffOIC <br /> Oil&Water.Non-RCRA Hazardous Waste Liquid CA221 Gal. ACCOUNT <br /> Waste Solids and Sludges Gal. 11CO 41173�[ <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 Hazar s Water Gal. <br /> TEST: Clor D Tech 40004?M—ppm ❑Clor D Tech 1005 Pass❑Fail ❑ Btu: Detector/Flam est ❑Pus ❑ Fail 't„y,70 <br /> Field Service Work Description: Total Char-es <br /> Other. <br /> Other <br /> Vacuum Se ices Time Z J / <br /> Out of Y d On Site Off Site_Off Load Stan Off Load En Return to Yard 4oS <br /> TS Consolidated ifest <br /> Evergreen Oil,Inc. Evergreen Env.Svc. Evergreen Env.Svc. AJS Filter <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine1:1 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95926 Fresno.CA 93711 Industry.CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> Evergreen Env.Svc. Evergreen Env.Svc. ❑ CFR 1:1CFR Greenleaf Env.Svc. <br /> 16604 S.San Pedro 745 A West Betteravi 944 E.Slauson Ave. 33210 Western 3474 Toyon Circle <br /> Carson,CA 90746 Santa Maria,CA 93J64 Los Angeles.CA 90011 Union City,CA 94587 Valley Springs.CA 95352 <br /> CAD981696420 CAD982446858 I CAL000110021 CALM0091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: ❑Collection Station I Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑Marine ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> bind the above listed a rator to the terms on the reverse <br /> Ret sample # G side of this/form. <br /> Zc� 18 1 .3 V <br /> D ' er Signature Print Name Route# ate Generator's Signature Print Name Dale <br />