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WORK ORDER/SERVICE AGREEMENT <br /> Evergreen dEnvironmental Services No 19 7 3 3 0 <br /> _ p f 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 Dat <br /> GENERATO JOB LO ATO BILLING INFORNIATIO <br /> NAM NAM CASH❑ CHECK❑ <br /> Affo �f�j r - # <br /> /A I '^ ADDR % % CU IE <br /> CIT <br /> 6-S ATE — ZH CO. CITY S A CO. PO# <br /> O E N10. PHONE NO. PR FILE NO. US OMER EPA ID NO. <br /> c ) J Y <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Gal, <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Automotive Antifreeze,Non-RCRA Hazardous <br /> waste Liquid CA134 Gal. <br /> ible Li d,N. .S. _ <br /> I ater,No -RCRA ardous Waste Li uid CA221 Gal. <br /> Wash Out Each <br /> Drained Used Oil Filters Drum <br /> Non-RCRA Hazardous Waste _ y Drum <br /> Empty Drums Drum <br /> Transportation Hrs. <br /> Aa <br /> TESTIL Clor D 4t:h 4000 ppm ❑Clor D Tech 1000❑Pass❑Fail ❑ Halogen Detector/Flame Test ❑Pass ❑ Fail <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum Services Time �f <br /> Out of Yard On Site Off Site Off Load Start Off Load End Return to Yard <br /> TSDF 7 Cohsolidated Manifest <br /> ❑ Evergreen Oil,Inc. ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. AJS Filter �7 <br /> 6880 Smith Ave. Road 3013 4139 N.Valentine' 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 dustry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ CFR &C31 <br /> Re ��16604 S.San Pedro 745 A West Betteravia 944 E.Slauson Av210 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 CAL000091507 CAL000214411 <br /> Source: Collection Station L)Government Generator certifies that it has established a program to reduce the volume or <br /> 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 2enerator to the terms on the reverse <br /> Retain sample # / side of this r <br /> Driv Slgnatu e P nt e Route# Date Genera r 'Signature P ' t Name Date <br />