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12/16/03 17:25 NORTH'^Y FRENCH CAMP 4 2094683433 NO.214 910 <br /> WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services <br /> dedtcare�to the pnvrecrion of rhe enviram"m N—o . 131013 <br /> To srhedt le a pickup, call Send payment to: Sales Order# <br /> 800-972-5284 Evcrgaeen Oil,Inc. <br /> NM&.ff r A.aa_,%mvic,CA E CAD982413?.t32 Dept. 2457 <br /> 11/540 s.Sam Padm SL,Games, A tPAe CAosB2at32fi2 Los Angelcs,CA 90084-2457 Date: C213 <br /> GENERATOR/JOB LOCA ON BILLING INFORMATION <br /> NAM NAME CAM❑CHECK <br /> ,1'1v <br /> ADDRESS ADDRESS CU 14SER CODE NO. <br /> / M 'q <br /> Cm STA. 71P CO. CII'Y STATE ZIP CO. PO <br /> Z4 I ,j <br /> ONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA N0. <br /> t;.alcrotl <br /> PRODUCT WAS'T'E MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used 61.Nan-RCRA HavaTdrws Lubricating CA221 . - ; i Jae Cral. r � <br /> Waste,Impid Industrial CA221 Gal. <br /> LBW A.-*wa�A t-acaA a <br /> wage CA l34 Gal. <br /> KQ Wm Ca®L�Int,h.OS.NA I''�1 HR002 Gal. <br /> Oil&Water,Hoo-RCRA Hazardou�Waste Liquid CA221 Gal- <br /> Waste Solids and Sludges Gal, <br /> Wash Out Each <br /> Drained Used Oil Filters Ilium <br /> Nun-RCCA Hazardous Waste Solids(oYly debris) CA223 Thum <br /> Empty norma Drum <br /> Traawortati Hrs, <br /> Nan Water C> , <br /> TEST: Clear D Tech m ❑Clor D Tech 1000 Pass❑Fail ❑ Halogen Deleetrnlmamc Tcbc ❑?4S ❑Fail 2GQ _—XO <br /> Field Service Work Descriptitm Total Charges <br /> odor <br /> Other_ <br /> Vitcuum 1 cmc II <br /> tArt Y Oo Site O�Site Off Load Start Off Load Ud Reram to Yard (Ap <br /> %58U0 <br /> Consolidated Manifest <br /> gteen Oil,lac. n E�teen Env.Svc, Fvetgrm%Env.Svc, A75 Filter <br /> Snti Ave. t- 1 R 30H ❑4139 N.Vulendne 11 15131 Clark An. <br /> Newark.CA 94560 a,via,CA 95926 Fresno,CA 93711Industry CA 91745 <br /> CAD9808874t8 82446674 CAD982446862 CA117432 <br /> DEyap=Env.Svc, E Env.Svc. ❑CPR ❑ CFR � Greenleaf Env.Svc. <br /> 166D4 S.Sall 74 West Hetteravia 944 E.Slauson Ave. 33210 Western 3474 Toyyman Circle <br /> Cursor,,CA 90A Sa0a Maria,CA 93.1.54 Las An,geies,CA 9001 t Union Ciry,CA 94587 Va11�y Springs CA 95352 <br /> CAD9816964 CAD98244695e CAI,0001 Ml CAL.000091507 CAL0002144I I <br /> Generator certifies that it has established a pragraan t❑reduce tho vvlamc or <br /> Source: Collection Station ❑GOvernrnent quantity&toxicity of the hazardous waste to the dcgrce determined by <br /> ❑Marine 0 Agricultural ❑Industrial ganentoc to be ettmamwally practicable. <br /> I ht> k mTdl drat I have road lull/have the authority tD <br /> Re D sample # G brad the above IJAW generator to the terms on the reverse <br /> P side of this form. <br /> ZO $ <br /> Drf Signature Na1ne Route# ate erator's Signature Print Namee: � at� <br />