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2011-Feb-11 02:10 PM DSW AG 209-339-8867 23/42 <br /> WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Er vilronmental Services N° 306414 <br /> drdlrumd/n 10/imilevilon of rhe envirmonvirl I. <br /> To schedule a pickup, call wnd paylncnl tir Sales Order#�"" <br /> 800-972-5284 Evergreen Oil, Inc. <br /> 6860 Smith Ave.,Newark,CA EPA#C D282413262 P.O. BOX 30517 <br /> 16540 S.San Pedro St.,Carson,CA E Att CAD962413292 Las Angeles, CA 90030-0517 Data: 1 ZU 16 -� <br /> GENERATOR41013 LOCATION BILLING INFORMATION <br /> ME NAME CASH❑CHECK=ni ❑ <br /> ADDRESS ADDRESS USTOMER CODE N0. <br /> I Y STATE ZIP CO. CITY STATE ZIP CO. P #IL <br /> O <br /> PHONE. NO. PHONE NO. PROFE NO. CU ' OMER EPA 1D N0. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Ul;ed oil,Nnn-RC1 azardous Lubricating CAW] �sv <br /> Waato,Liquid ' Ind atrial 7Al2) Gal, <br /> Utast AulnmOoo Anafnma.Nim•RCRA ttvankm� CA 134 Gal. <br /> ul <br /> 0.O w,.,.eaniMralht.lJN■Id.N.d.A Nn Cn2^I <br /> mlal Ih I . FIXII/F0a2 Gal. <br /> Oil Water,Non•RCRA Hn>ardoua Wrist Liquid CA221 Gal. <br /> Write Solids and Sludges Gal. <br /> Wash Out Each <br /> DtMlned Wed Oil Filters Drum <br /> Non-RCRA Hamrdaus Wastc Solids(oily obris) CA223 Drum <br /> Empty Drums Drum <br /> Trionrportatlon HB. <br /> Non Harntdous W cr Gal, <br /> Glycol Bulk swo Gal. <br /> Glycol BUI• Cone. Oal, <br /> TEST: Clor D Tech 4( 02--ftpmID Clor D Tech ]UGUrAPosit 711'," ❑ Halogen DetectorRame'rest ❑Y ❑Puil <br /> Pield Service Work Description: <br /> Other: <br /> Other: <br /> Vacuum S ices Time <br /> Out of Y On Sita ff Site Off Load Start Off Load End Ret Ifo to Yard <br /> Y68RIlRI80 <br /> Consolidated Manifest <br /> rgroen Oil,Inc. ❑ E'vergree Env.Svc. 11Evergreen Env.Svc. L1 A}S Filter <br /> Smith Ave. Rand 30 4139 N.Valentine 15131 Clark Ave. <br /> Ncwark,CA 94560 Davis.CA 95616 Fresno.CA 93722 Indus uvyy CA 91745 <br /> CAD990SH7418 CAD932 6874 CAD982446882 CAD00009T43Z <br /> Evergman Env.Sv EverLLrae Env.Svc. CFR CFR Greenleaf Env.Svc. <br /> 16604 S.Sun Pe > 745 A W at Bcncravia t}44 E.Slaunn Ave. 33210 Western 3474 Toyon Circle <br /> Carxan,CA 90 6 Santu Ma a,CA 93454 Los An los,CA 90011 Union City,CA 94587 Valley Spring&,CA 95352 <br /> CAD98169 CAD9824A,6958 CAL000110021 CAL000091507 CAL00021441I <br /> Gcncratar ccrtifrca that it has catabliahod a program to reduco the volume or <br /> Source: Collection StaticIt ❑ Government quantity&toxicity of the humrdaus waste to the degree determined by <br /> Q Marine ❑ Agricultural Cl Industrial generator to be economically prnc6cabie. <br /> I hereby certify that I have read and have the authorlt)• to <br /> bind the above listed 2enerator the terms on the reverse <br /> R ain sample # side of this form. <br /> 1) r Signature Print Name Route# aEe er nature Print Name Date <br /> Sys •.- <br /> Th <br /> •rti l <br /> y�; f <br /> I <br />