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t • • <br /> WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services N° 224282 <br /> 41 dedicated to the protection of dee enrtrmimenl <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 INFORIMATION <br /> N F. NAME CASH❑ CHECK <br /> ADDRESS y ADDRESS C TOMER CODE NO. <br /> I � / OZ <br /> CIT ' STATE ZIP CO. CITY STATE ZIP CO. PO N <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Z ZZO Gal. '+ <Zmr�� <br /> Waste,Liquid Industrial CA221 Gal. <br /> Usw.Aummonw Amft[eze.No„-r,CRA haertR,u, CA134 <br /> Wu,,.Liquid Gal. <br /> RQ Wan,Cmnbus(iMe Liquid.N 0.NA CA221 <br /> I g94[if(Oil ugntnmioeul wial hulowo1) F(N)I%Hg2 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 /> Transportation Hrs <br /> Non Hazard Water Gal. <br /> TEST: Clor D Tech 4000_Z4s2_ppm ❑Clor D Tech 1000 Pass ❑Fail ❑ Halogen DetectoriFlame Test ords, ❑FailLj. _-Pb <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum rvices Time <br /> Out of and On Site Off Site Off Load Start Off Load End Ret to Yard <br /> TS F 14Consolidated Manifest <br /> Evergreen Oil,Inc. �.Evergreen Env.Svc.. 1:1Evergreen 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 /> CAD990887418 � CAD982446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen E/94d6. <br /> ie. ❑ Evergreen Env.Svc. ❑ CFR CFR ❑ Greenleaf Env.Svc. <br /> 16604 S.Sae745 A West Betteravia 944 E. Slauson Ave. 1J 33210 Western 3474 Toyon Circle <br /> Carson.CA Santa Maria.CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696CAD982446958- CAL000110021 CAL000091507 CAL00021441I <br /> Source: Collection Station ❑Government quantity <br /> 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 /> Vain <br /> I hereby certify that I have read and have the authority to <br /> `J , bind the above listed generator to the terms on the reverse <br /> sample # Z L T side of this form. - <br /> D er Signature riot Name Route # ( Dae ur's S1gn 1 e Date <br />