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WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services N° 298099 <br /> / dedicated to the protection cf the environment <br /> To schedule a pickup, call Send payment to: Sales Order#iLQ3R�_A-h757 <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: <br /> GENERATORIJOB LOCATION BILLING INFORMATION <br /> N NAME CASH❑ CHECK❑ <br /> DURESS ADDRESS /J CUSTOMER CODE NO. <br /> 't 'or" " 5wMamin <br /> ES L�C�.7 <br /> CITY STATE ZH' CO. CITY STATE ZIP CO. PO# <br /> PHONE NO. PHONE NO. PROFILE NO. a4vwabw <br /> PRODUCT WASTE MANIFEST <br /> CODE NUMBER QUANTITY UNITS PRICE AMOUNT <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 L y7 y 4/ Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Aulomodvc Andf.,Nou-RCRA ttamrdaus CA134 Gal. <br /> Wvne Li wd <br /> RQ Was¢Combustible liquid,N.O.S.NA CA221 Gaf <br /> iv <br /> io it <br /> od canumina'd wi6 halo. FU01/F0o2 <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 Dmms Drum <br /> Transportation Hrs. <br /> Non Hazardous W r Gal. <br /> Glycol Bulk 50/50 Gal. <br /> Glycol But Cone. Gal. <br /> TEST: Clor D Tech 40007.1Z_-ppm ❑Clor D Tech 1000 Pass❑Fail ❑ Halogen Detector/Flame Tut ❑ s ❑Fail <br /> Field service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum Services Time <br /> Out of d On Site Off Site Off Load Start Off Load End Re to Yard <br /> TS F Consolidated Manifest <br /> Ever6880 Smith Ave.Avec Road 30B een Env.Svc. Eve4139 N�Valwtinen Env. c. A!3Filter <br /> Clark Ave. r <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Industry;CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> ElEvergreen Env.Sv . Evergreen Env.Svc. ❑ CFR 1:1CFR 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 9 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD9816964 CAD982446858 CAL000110021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station ❑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 /> e in sample # 3 G bind the above listed generator to the terms on the reverse <br /> side of this form. <br /> /.l _�� '. <br /> D er Signature riot Name Route# ((( Date enerator's Signatur Print Name Date <br />