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WORK ORDERISERVICE AGREEMENT <br /> Evergreen Environmental Services ° 313527 <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send pa3 went to: S rder# <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:2�Z <br /> GENE OR/J B LOCATION BILLING INFO TION <br /> NAE <br /> CASH❑CHECK❑ <br /> ADD S$S �l ADDRESS # <br /> (J v D ZC O <br /> CIT -5TA,TE /CO. CITY TAT <br /> [� �j PHONE NO. PROFILE NO�� CU TOMER EPA ID NO. ,-y <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> w:m Lumma.:Aner�Non-RCRA w,,,aous CA134 Gal. <br /> RQ wave Cnmbos011 Liquid,N OS.NA CA221 <br /> laaam ou�rmmw..m n.le.m awlnao2 Gal. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal <br /> Wash Out <br /> 3DetWVtofM=c <br /> Drained Used Oil Filters Non-RCRA Hazardous Waste Solids(oily debris) CA223 Empty Drums <br /> Transportation Non Hazardous Water Glycol Bulk 50/50 Glycol Bulk Cone.TEST:❑ Clor D Tech 40001 ❑Clor D Tech 1000❑Pass❑Fail ❑ Halo70Fail <br /> Field Service Work Description: otal ❑laraes <br /> Other: <br /> Other. ) <br /> Vacuum Services Time <br /> Out of Yard On Site Off Site Off Load Start Off Load End—Return to Yard <br /> TSDF ❑ Consolidated Manifest <br /> ❑ Evergreen Oil,Inc. F-] Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ AJS Filter El <br /> 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 /> I—I Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ CFR FR ❑ Greenleaf Env.Svc. <br /> {—I 16604 S.San Pedro 745 A West Benemvia 944 E.Slauson Ave. 33210 Western 3474 Tryon Circle <br /> Carson,CA 90746 Santa Maria,CA 93454 Los Angeles,CA Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD981696420 CAD982446858 CA1_A00110021 CALM0091507 CALM14411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: ❑Collection Station C3 Government <br /> 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 /> bind the above listed generator to the terms on the reverse <br /> Retain sample # side of this form. <br /> tZil <br /> Driver Sig re am e Route# Date Generator's Si at a Print Name Date <br />