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WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services No 199755 <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: Sales Order# (�Z2 <br /> 800-972-5284 Evergreen Oil, Inc. <br /> 6880 Smith Ave.,Newark,CA EPA#CA0982413262 P.O. BOX 678252 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Dallas,TX 75 267-8 25 2 Date:4PPI9`'1_ <br /> GENERATORIJOB LOCATION BILLING INFORMATION <br /> NA E NAME CASH❑CHECK❑ <br /> �L✓1 r /7 N <br /> A RESS ADDRESS CUSTOMER CODE NO. <br /> 2D l <br /> CITY STATE ZIP CO. CITY STATE ZIP CO. CPOA <br /> G4 962 " <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA It NO. <br /> ( ) <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Nan-RCRA Hazardous Lubricating CA221 Z11/1ZIF11 Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> w AuiommiL ve Anliaeer<,Non-RCRA ffm, x. CA134 Gal. <br /> U wd <br /> RQ W_ mmN.O.S.NA CA221 Gal <br /> 193nl Wwwne <br /> fid IA 2 <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 Hazardop Waste Solids(oily debris) CA223 Dru <br /> Empty Drums to <br /> Transportation His. <br /> .Non Hazy us Water Gal. <br /> TFST:ZClor D Tech 400020--ppm ❑Clor D Tech 1000 Pais❑Fail ❑ Halogen De odFlame Test ❑Pass ❑Fail 7W1-'ft <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other <br /> Vacuum ervices Time /�� l� <br /> Out of and on Site Off Site_Off Load Start Off Load End Rettun Yard r' <br /> TS Consolidated Manifest <br /> Evergreen Oil,Inc. Evergreen Env,Svc, Evergreen Env.Svc. ❑ AJS Filter <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine 15131 Clark Ave. ._ <br /> Newark,CA 94560 Davis,CA 95926 Fresno,CA 93711 Industry CA 91745 <br /> CAD980887418 CAD982446874 C.AD982446882 CAD000097432 <br /> Evergreen Env.Svc. F-1 Evergreen Ene.Svc. YAL0001100-11 <br /> CFR Greenleaf Env.Svc. <br /> 16604 S.San Pedro ��J 745 A West',,'cavi. Slauson Ave. 33210 Western 3474 Toyon Circle <br /> Carson,CA 90746 Santa Maria,CA 93454 geles.CA 90011 Union Ciryy,CA 94587 Valley Spnngs.CA 95352 <br /> CAD981696420 CA[)982446858 C.A[.00W91507 CAL0009_14411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: 0 Collection Station ❑Gov ment —� 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 /> P �o G/ bind the above listed generator to the terms on the reverse <br /> Ret sam �e # side of this form.N� ^ <br /> Zo X19 no a `/_ <br /> Dr ignature riot Name Route# ate Gener urs Signature tint Name Date <br />