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A/ WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services NO- 190489 <br /> / dedicated m the protection of rte environment <br /> Toschedulea pickup, call Send paJment 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: r_r`'�_ <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> N E NAME CASH ❑ CHECK❑ <br /> ADDRESS ADDRESS CUSTOMER CODE NO. <br /> � p <br /> CITY" STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> CA at JZ'—V— <br /> PHONE <br /> oP ONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> 1 <br /> �1) — ( ) WalO $ <br /> PRODUCT WASTE I MANIFEST <br /> CODE I NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Z� Gal. ?7 <br /> Waste.Liquid Industrial CA221 I Gal. <br /> UsW Aulummive Anuft e ,Non-RCRA Hvz ,tls <br /> wGal. <br /> dm a and CA 134 <br /> Rn Wmru Cn,nbusuble liquid.N.0.5.NA CA2'I <br /> M3 In(Oil.bnta M'm MiA h,lo ens Fool/Fo02 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 Hazard ou Waste Solids(oily debris) CA223 Drum <br /> Empty Drums Drum <br /> Transportation Hrs, <br /> Non Hazer sWater '__' Gal. <br /> TEST: Cior D Tech 400t�_ppm ❑Clor D Tech 1000 Pass ❑Fail ❑ Halogen Detector lame Test ❑P ❑Fail <br /> Field Service Work Description: + Total Charges <br /> Other: <br /> Other: <br /> Vacuum ices Time _ <br /> Out of art- - On Site -Off Site Off load Stan 4 Off Load End - Retum to YS- <br /> TS F Consolidated Manifest <br /> Evergreen Oil,Inc. Evergreen Env.Svc. Evergreen Env.Svc. AJS Filter <br /> 6880Smith Ave. Road 30B F-14139 N.Valentine ❑ 15131 Clark Ave. ❑ <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD986887418 CM82446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen Env.Sv . ❑ Evergreen Env.Svc. ❑ CFR 1:1CFR ❑ Greenleaf Env.Svc, <br /> 16604 S.San 745 A West Betteravia 944 E.Slauson Ave. 33210 Western 3474 rayon Circle <br /> Carson,CA 90 6 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD9816964 CAD982446858 CAL000110021 CAL000091507 CAL000214411 <br /> Source: Collection 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 /> ❑Marne ❑ 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 /> e 'n sample # G 2 side of this form. <br /> S fo <br /> r <br /> er Signature Wrint Name Route# Date enerator's Signatu Print Name Date <br />