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• • <br /> WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services <br /> SirN� 287902 <br /> dedicated to the pro'tdction of the environment <br /> To schedule a pickup, call Send payment to: Sales Order A11=3 8441:5 <br /> 800-972-5284 Evergreen Oil, Inc. <br /> 68M Smhh 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 /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NJ? NAME CASH❑CHECK❑ <br /> ADDRESS _ ADDRESS CU OMER��QQDE NO. <br /> L <br /> CI STATE ZIP CO. CITY STATE ZIP CO. PO# <br /> 9 <br /> ONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> " 1/ ( ) L'-'ApZ'+7LjE <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 a&/ 7Gal. <br /> Waste,Liquid Industrial CA221 Gal, <br /> Uxd Au 0__Andric.Non-RCRA Huardaus CA134 Gal. <br /> w Li uid <br /> RQ W..Co.WsdbR liquid N.O.s.NA CA221 <br /> 1993 UI Oil mnNmineRd wiN hab F001/002 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 Hazardous Waste Solids(oily debris) CA223 Drum <br /> Empty Druns Drum <br /> Transportation Hrs. <br /> Non Hazardous ater Gal. ~ <br /> Glycol Bulk 50/50 Gal, <br /> Glycol Bu Cone. Gal, <br /> TEST:ffclor D Tech 4000ZP!�_ppm ❑Cl—D Tech 1000 Passr <br /> ❑Fail [1 Halogen Detector/Flame Tes ❑Pass ❑Fail �, fJ <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum rvices Time <br /> Out of ard On Site Off Site Off Load Stan Off Load End Return to Yard �7 v— <br /> T F Consolidated Manife <br /> Evergreen Oil,Inc. ❑ Evergreen Env.Svc. ❑ Evergreen Env.Svc. 1:1AJS Filler <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine 15131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen jnvSv . Evergreen Env.Svc. ❑ CFR ❑ CFR Greenleaf Env.Svc. <br /> 16604 S.S 745 A West Betteravia 944 E.Slauson Ave. 33210 Western 3474 Toyon Circle <br /> Carson,CA Santa Maria,CA 93454 Los Anggeles,CA 90011 Union CityCA 94587 Valley Springs,CA 95352 <br /> CAD98169CAD982446858 CALOOOII0021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station ❑Government quantity&tonicity of he hazardous waste to he 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 /> sample # side of this form <br /> n m <br /> D er Signature nt Name Route# ate Generator's Signature t Name Date <br />