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• <br /> WORK ORDERISERVICE AGREEMENT <br /> Evergreen Environmental Services N° v <br /> dedicated to the protection of the em ironment <br /> To schedule ar�pickupp, 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: 'Z <br /> tcrs— <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NA G ,NAME CASH❑ CHECK❑ <br /> rrytya� � # <br /> ADDRESS ADDRESS Cu ,QME£R��DE NO. <br /> C STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> 97 Z-1 <br /> t ) b <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER QUANTITY UMTS PRICE AMOUNT <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 7AWjrZ.167 20'o Gal. .� (®y'�: 5J <br /> Waste,Liquid Industrial CA221 Gal. <br /> USN ALi uiduumwrive Miibu�e,Nm-RCRA III.&. CAI 34 Gal. <br /> Wazte <br /> RQ Wase Combustible Liquid N.O.S.NA CART <br /> 1993 In Oil conwnimrcd with lino rns F601/1`002 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 Hazardou ante Solids(oily debris) CA223 Drum <br /> Empty Drums Drum <br /> Transportation firs. <br /> Non Hazer s Water Gal. <br /> TEST: Clor D Tech 4000u�pm ❑Clor D Tech 1000 ass❑Fail ❑ Halogen Detector/Flame Test ❑Pass ❑Fail <br /> op mcJ <br /> Field Service Work Description: Total Charges <br /> Other: <br /> O her. <br /> Vacuum ervices Time <br /> Onto and - On Site-Off Site Off Load Start 4 Off Load End-Retum <br /> TsF Z Consolidated Manifest <br /> Evergreen Oil,Inc. ❑ Evergreen.Env.Svc. ❑ Evergreen 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 /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> Evergreen Env.S Evergreen Env.Svc. ❑ CFR CFR Greenleaf Env.Svc. <br /> 16604 S.San Pe 745 A West Beaeravia 944 E.Slauson Ave. 33210 Western 3474 rayon Circle <br /> Carson,CA 6 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD98169 CAD982446858 CAL000110021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> pio,erSignaturpe <br /> Collection Station ❑Government quantity&toxicity of the hazardous waste to the degree determined by <br /> Marine ❑ Agricultural ❑ Industrial generntor 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 /> le #� � `� side of this form. <br /> Print Name Route# Date enerator's Sigti r rint Name Date <br />