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0 <br /> WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services N° 306428 <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: Sales Order# <br /> 800-972-5284 Evergreen Oil, Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CAD982413262 P.O. BOX 30517 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Los Angeles, CA 90030-0517 Date: 1 Z�►s'�.TS' <br /> GENERATOR(JOB LOCATION BILLING INFORMATION <br /> N NAME CASH❑CHECK E]/cry rcl �` # <br /> ADDRESS ADDRESS CU 9MER CODE NO. <br /> -%24_7_ L. `c'&o z <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. O# <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> 121 ( ) <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 �24Z1 Gal. -CP alp <br /> Waste,Liquid Industrial CA221 Gal. <br /> mane.mnwtise Mtifwc,Nan-RCRA Hvaraous (-•A134 Ga( <br /> RQ Was¢Cwnbueuble l.igd4 N.O.S.NA CA l <br /> RQ m Oil mma tbeL xiW hal FIpI/FUp2 tial. <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 /> Transportation <br /> Hrs. <br /> Non Hazardous Water Gal <br /> Glycol Bulk 50/50 Gal <br /> Glycol But Cone. Gal. <br /> TEST: Clor D Tech 40002p_ppm ❑Clor D Tech 1000Pass❑Fail ❑ Halogen Detector/Ftame Test Pass ❑Fail 'Z pp <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum Services Time <br /> Out of and On Site Off Site Off Load Stan Off Load End Re to Yard <br /> TS F 2 Consolidated Manifest <br /> Evergreen Oil,Inc. ❑ Evergreen Env.Svc. 1:1Evergreen Env.Svc. AJS Filter ❑ <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine 1:115131 Clark Ave. <br /> Newark,CA 94560 Davis,CA 95616 Fresno,CA 93722 Industry,CA 91745 <br /> CAD980887418 CAD982446874 CAD982446882 CAD000097432 <br /> Evergreen Env.Svc. Evergreen Env.Svc. ❑ CPR ❑ CFR ❑ Greenleaf Env.Svc. <br /> 16604 S.San Pedro 745 A West Betteravia 944 E.Slauson Ave. 33210 Western 3474 Toyon Circle <br /> Carson,CA 9gW46 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD98169 0- CAD982446RSR CALDOO110021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station El Government quantity&toxicity of the hazardous waste to the degree determined by <br /> ❑Marine C] Agricultural ❑ Industrial Iehereby certifvnerator to benomithat Iyhaverread and have the authority to <br /> bind the above listed generator to the terms on the reverse <br /> tain sample # L y side of this form. <br /> ate <br /> D ' er Signature Print Name Route# enerator's Signature Print Name Date <br />