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WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services ° 273652 <br /> / /NNdedicated to the protection of the environmN <br /> ent � � <br /> To schedule a pickup, call Send payment to: Sales Order S/ .,0 <br /> 800-972-5284 Evergreen Oil, Inc. <br /> 6880 Smfth 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 /> GENERATORIJOB LOCATION BILLING INFORMATION <br /> N NAME CASH E]CHECK E] <br /> ADDRESS ADDRESS CU TOMER CODE NO. <br /> r� L�b?02 <br /> CI STATE Zn' CO. CITY STATE ZIP CO. P # <br /> ONE NO. PHONE NO. PROFII,E NO. CUSTOMER EPA ID NO. <br /> ( ) pl <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 ] ZZO Gal. 7,;"---Z, 7 <br /> Waste,Liquid Industrial CA221 Gal. <br /> CA134 Gal. <br /> RQ w G==hk Liquid N.O.S.NA CA221 <br /> Igasm ou cvovo,m.rm.w,tivo tU0llFlx12 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 Dmm <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum <br /> Empty Drums Drum <br /> Transportation <br /> His. <br /> Non HazardousWater Gal, <br /> Glycol Bulk 50150 Gal. <br /> Glycol Bulk Cone. 77 Gal. <br /> TEST: Clor D Tech 4001Y6Qppm p Chun Tech 1000 Pass ❑Fail ❑ Halogen Detector/Flame Test Pass ❑Fail Zz:, ZFZ�l <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum ervices Time <br /> Out of azd On Site Off Site Off Load Stan 4 Off Load End R to Yard "so <br /> TS COnsOlidated Manifest <br /> Ever68805'th Avec ❑ Readgreen 30B Env.Svc. [:] Everen Env.4139 N.Valentine3 <br /> Svc. <br /> ❑ 5I <br /> 1 Filter <br /> Ave. ❑ <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Industry,CA 91745 <br /> CAD980887418 / CAD982446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen Env.Syl:. ❑ Evergreen Env.Svc. ❑ CFR ❑ CFR ❑ Greenleaf Env.Svc. <br /> 16604 S.San P ro 745 A West Betteravia 944 E.Slauson Ave. 33210 Western 3474 Toyon Circle <br /> Carson,CA 9 46 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valle yy Springs,CA 95352 <br /> CAD981696 0 CAD982446858 CAL0001I0021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: A Collection Station ❑Government I 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 /> R in sample ! bind the above listed generator to the terms on the reverse <br /> [I side of this form. <br /> Z40;i5Z L N <br /> Iver Signature Print Name Route# Date 'generator's Sign re Print Name Date <br />