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WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services No 2 5 <br /> / dedicated to the protection of the environment <br /> 9272 <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 Dateslzzb�!!! _ <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> Nn <br /> c �// - NAME #CASH El CHECK E]✓1 !f0r <br /> ADDRESS ADDRESS CU TOMER CODE NO. <br /> c- Lso 0 <br /> CI Y STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> 9 — ( ) 1 <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 ( Gal. Z5' «p <br /> Waste,Liquid Industrial CA221 Gal. <br /> w�u,�° A.uf�,No.-RCRA unam s CA134 Gal. All, .r�O <br /> RQ Wn n,C.mbustibk Liquid,N.O.S.NA CA221 <br /> 1 ov,u. Oil c.=nnn,¢ with M1alo na 1` 01l 002 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 /> Transportatio Hrs. <br /> Non H us Water Gal. <br /> TEST: Clor D Tech 4Wg4.A2ppm ❑Clor D Tech 1000 Pass ❑Fail ❑ Halogen DetectodFlaree Test ❑Pass01pirl <br /> 2jes Field Service Work Description: T <br /> Other: <br /> Other: <br /> Vacuum Services Time <br /> Out ofab On Site OH Site Off Load Stan Off Load End Return to Yar <br /> TS Consolidated Manifest <br /> Evergreen Oil,Inc. Evergreen Env.Svc. Evergreen Env.Svc. ❑ AJS Filter ❑ <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen Env. a ❑ Evergreen Env.Svc. ❑ CFR 1:1CFR ❑ Greenleaf Env.Svc. <br /> 16604 S.San P to 745 A West Betteravia 944 E.Slauson Ave. 33210 Western 3474 rayon Circle <br /> Carson,CA 9 46 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD98169 0 CAD982446858 CAL000110021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station C]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 generator to the terms on the reverse <br /> tin sample # 7A'A--42 side of thi rm. <br /> 4"' e7 <br /> ver Signature Print Name Route# Date G ator' Signature VPrint Name Date <br />