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WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services No 321288 <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: <br /> Sales order# <br /> 800-972-5284 <br /> Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 P.O. BOX 30517 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles, CA 90030-0517 Date: <br /> GENERATORIJOB LOCATION BILLING INFORMATION <br /> 2ADDRESIS,, <br /> NAME <br /> CASH❑CHECK❑ <br /> ADDRESS # <br /> SCU TOMER CODE NO. <br /> STATE ZIP Co. CITY L QQ <br /> STATE ZIP CO. PO H <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> ltdcl 14 7^ ( ) <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 y Gal <br /> Waste,Liquid Industrial CA221 Gal. <br /> Utt A w Anti ,Non-RCRA 11 w CA134 <br /> waz n,a Gal <br /> RQ Waz-C.m tibkLiquid,N.O.S.NA CA221 <br /> 199""1 oil Jnr nanum wim Ma n ]POMA ou2 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 <br /> Drum <br /> Transportation Hrs. <br /> Non Hazardous Wa Gal <br /> Glycol Bulk 0/50 Gal <br /> Glycol Bulk Cone. Gal <br /> TEST: Clor D Tech 40007 ppm ❑Clor D Tech 1000 Pass❑Fail ❑ Halogen Detector/Flame Test as ❑Fail <br /> Field Service Work Description: Total Chas eS <br /> Other: <br /> Other: <br /> Vacuum Services Time <br /> Out of ard On Site Off Site Off Load Start Off Load End Return to <br /> TS VConsolidated Manifest <br /> Evergreen Oil,Inc. ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ AIS Filter <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine ❑ <br /> 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> Evergreen Env.S Evergreen Env.Svc. ❑ CFR CFR ❑ Greenleaf Env.Svc. <br /> 16604 S.San Fe 745 A West Betteravia 944 E.Stan Ave. 33210 Western 3474 Tryon gCircle <br /> 90 CarAD9S169 6 CarAD982446858 ta Maria,CA 93454 Lo ACALOOOngeles, l 90011 CUnion AL�91 07 94587 C�1 y 214411 CA 95352 <br /> rSignature <br /> tion Station ❑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 /> e ❑ Agricultural ❑ Industrial generator to be economically practicable. <br /> I hereby certify that I have read and have the authority to <br /> u bind the above listed generator to the ten on the reverse <br /> I side of this form. <br /> S$ C`! <br /> int Name Route# ate nerator's Signature <br /> at Name Date <br />