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0 <br /> WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services213 9 9 9 <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send pacnlent n.. 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:—r <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NA C NAME CASH❑CHECKorwe At <br /> ❑ <br /> ADDRESS G ADDRESS C=NO. <br /> CODEd2 NO. <br /> CIT I STATE ' ZIP CO. CITY STATE ZIP CO. PO At <br /> 4s <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> 4 ( ) I CA <br /> PRODUCT WASTE MANIFEST QUANTITYflGal. <br /> PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 z31'V,wz Gal. <br /> Waste,Liquid Industrial CA221 W M Auw.Active Antitaze.Non-RCRA H=rdM , CA134 RQ Warm Combustible uqui4 N.O.S.NA CA221"gom Oilnumhalo Fool/FOol Oil&Water.Non-RCRA Hazardous Waste Liquid CA221 . <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 Hazaz us Water Gal, <br /> TEST: Clor D Tech 4000L4yappm ❑Clor D Tech 1000 E Pass❑Fail ❑ Halogen DetectorMame T st ❑Pass ❑Fail 31, <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum S ices Time <br /> Out of Y d On Site Off Site—Off Load Start Off Load End Return to and 4'� <br /> TSD Consolidated Manifest <br /> Evergreen Oil,Inc. Evergreen Env.Svc. ❑ Evergreen Env.Svc. AlS Filter <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine 1 1 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 — <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen Env.S ❑ Evergreen Env.Svc. ❑ CFR CFR Greenleaf Env.Svc. <br /> 16604 S.San P m 745 A West Bettetavia 944 E.Slauson Ave. 33210.Westem 3474 rayon Circle <br /> Carson,CA 9 46 Santa Maria,CA 93454 Los Anggeles,CA 90011 Union City,CA 94587 Valley.Springs,CA 95352 <br /> CAD98169 _0 CAD982446858 CAL000110021 CAL000091507 CAL0002144I t <br /> Source: Collection Station CJ Government Generator certifies that it has established a program to reduce the volume or <br /> quantity&toxicity of the hazardous waste tq 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 /> Rt in sample # 7 C_ �� 3 side of this fom. <br /> `1 <br /> ver Signature nt Name Route# I D togenerator's Signature Print Name Date <br />