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• <br /> 1 <br /> WORK ORDER/SERVICE AGREEMENT <br /> 10 <br /> Evergreen Environmental Services No <br /> dedicated to the protection of the environment <br /> - 242561 <br /> To schedule a pickup, call Send payment to: Sales Order # O'sQo?CC0;r <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: _ b c� <br /> GENERATOR/70B LOCATION BILLING INFORMATION <br /> 2m <br /> NAME CASH ❑ CHECK❑ <br /> ADDRESS ADDRESS C TOMER CODE NO. <br /> o <br /> CIT STATE ZIP CO. CITY STATE ZIP CO. O# <br /> G0 �2.�to <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> ( ) @000 <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 O Gal. ,:AD .--it. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Aummudve Aniif a w.Non-RCRA HmsNous CA 134 <br /> wss,r a�,d Gal. <br /> RQ Wase Combustible Liquid,N.O.S.NA CA22I <br /> ,.3 m Oil conNmina.wiN silo,.. wor/Fuo2 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 /> Transportatio Hn. <br /> Non Haz ous Water Gal. <br /> TEST:ItClor D Tech 4000 Z ppm ❑Clor D Tech 1000 jPass❑Fail ❑ Halogen Detector/Flame Test ❑ P ❑Fail 2kp,=b <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum ervices Time <br /> Out o and On Site Off Site Off Loa Start Off Load End Rehm t Yard <br /> TS F Consolidated Manifest <br /> Ever en Oil.Inc. Evergreen Env.Svc. Evergreen Env.Svc. AIS Filter <br /> 6880Th Ave. ❑ Road 30B ❑ 4139 N.Valentine ❑ 1513] Clark Ave. ❑ <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980887418 CAD482446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen Env. e. ❑ Evergreen Env.Svc. ❑ CFR ❑ CFR ❑ Greenleaf Env.Svc. <br /> 16604 S.San P o 745 A West Betteravia 944 E.Slauson 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 /> CAD98169 0 CAD982446858 CAL000110021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station LJ Government quantity&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 /> t <br /> sample # 7c. bind the above listed generator to the terms on the reverse <br /> side of this form. <br /> Dri Signature Print Name Route# Uate Generator's Signature Print Name Date <br />