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WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services No 3 7 <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 /> 6680 Smith Ave., Newark,CA EPA#CAA#CA 982 P.O. BOX 678252 <br /> 267-82 '� /� <br /> 16540 S. San Pedro St,Carson,CA EPA#CAD982413262 Dallas, TX 75267-8252 Date: <br /> GENERATORIJOB LOCATION BILLING INFORMATION <br /> NA NAME CASH❑ CHECK❑ <br /> ADDRESS ADDRESS COS 01 ER CODE NO, <br /> CITzpvo Y STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID N0, <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 - 7 Gal. . 65rA <br /> Waste,Liquid Industrial CA221 Gal. <br /> Au[ammive Mufrteu.Non-RCRA Wrallous CA134 Gal. <br /> RQ W.f Co.buvibl<liquid.NOS.NA CAM <br /> JW31EIoa<anmminv<a.am baro n: wottr0a Gal. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Ga(, <br /> Wash Out Each <br /> Drained Used Oil Filters Drum <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum <br /> Empty Drumsif Drum <br /> Trausporlali Hrs. <br /> Noou <br /> n Haz s Water I Gal <br /> TEST: Cior D Tech 4000r,4b,--ppm ❑Clor D Tech 1000 . Pass❑Fail ❑ Halogen Detector/Flame 4t ❑Pass [:]Fail <br /> Field Service Wort Description: Total Charges <br /> Other: <br /> Other: <br /> Vacu Services Time �+ <br /> Out f Yard On Site Off Site Off Load Start Off Load End Return to Y +7 <br /> T F Consolidated Manifest <br /> 2Evergreen Oil,Inc. 1:1Evergreen Env.Svc. Evergreen Env..Svc. ❑ AiS 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 Svc. ❑ Evergreen Env.Svc. ❑ CFR � CFR � Greenleaf Env.Svc. <br /> 16604 S.San edro 745 A West Betteravia 944 E.Slanson Ave. .33210 Western 3474 Toyon Circle <br /> Carson,CA 46 Santa Maria,CA 93454 Los Angeles,CA 90011 Union.City,CA 94587 Valley Springs,CA 95352 <br /> CAD981i 20 CAD982446858 CAL000110021 CAL000091507 CAL00021441t <br /> Generar certifies that it has established a program to reduce the volume or <br /> Source: Collection Station Ll Government quantityto&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 /> Re in Sam le # G .� Z bind the above listed generator to the terms on the reverse <br /> II �—I side of this f / <br /> 7 J. <br /> 1711 <br /> D r ignature A5rint Name Route# Date nerator s Signature Print N e Date <br />