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12/16/03 17:25 NORTP^X FRENCH CAMP 2094683433 NO.214 1?12 <br /> WORK ORDER/SERVICE AGREEMENT <br /> Evergreen Environmental Services <br /> dedicate tuo the protection of rhe envlronmenr 1`O 132090 <br /> To sched le a pickup,call Send payment to: Sales Order#9475. 1 <br /> 800' 72-5284 l7vergreen Oil,Inc. <br /> 6W SMO Ave.,Nawaric CA E A#CA0962413262 Dept. 2,457 <br /> 11654®S.San Pedro St.,Carron, A EPA#GA0962413262 Los Angcics,CA 90084-2457 <br /> C'E MTORIJOR YAC TION RMLING INFORMATION <br /> NAM NAME CASH❑C13ECK❑ <br /> ADIyItFSS CUST014IEIt CpD'NO. <br /> • r <br /> 47 <br /> CITY STA ZIP Co. CITY STATE ZIP CO. CCU12�M4nA <br /> NO. PHQNF NO, PRQPLLE NO. ID NO. <br /> ( ) P�gClisp <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used ojl,N0¢FRCRA Hazardous LuWL40vg CA221 Gad. <br /> Waste,Liqu d IuduKtrial CA221 Gal. <br /> � <br /> t rMmm�a,tyw-atxn CA134 ZZ49"] 7 Gal. <br /> R w Camd�fiLb Iiq� <br /> N. A11 Cpp�22I <br /> r m a rtmrtnamlwim�r Fo0(IFY12 1331. <br /> Oil&Warr,Nan-RCRA Hazardous'Waste Liquid CA221 Gat. <br /> Gritz Solids and Studges Gal. <br /> wash Out Each <br /> Drained Used Oil Filters Drum <br /> Nwn R TA Hazardous Waste Solids(oily debris) CA223 Drum <br /> Empty Drams Dnlm <br /> Tcansporiatiou Hrs. <br /> Non Hazardous Wa>r't Gal. <br /> TEST--E]C1or D Tech 4000 ❑C1oT 0 Tech HMO Pass❑Fail ❑ HAugen Detector/ lame Test ❑P Q Fail <br /> Field Soviet Work Description: Total Charaes <br /> other: <br /> Other. <br /> Vacunm roes 7lttte <br /> Out of d On Sitz Off Site Off Load Stec—4 Off Load End Rctum to Ya 17/1 <br /> Consolidated Manifest <br /> Evagrm Oil,Inca �""'� EV n Env.Svc. 11Evergreen Env.Svc. AIS Filter <br /> 68813 Smith Ave, u 308 4139 N.Valentine 15131 Clark Ave. u <br /> Newark,CA 94560, Da 'LH,CA 95926 Fresno,CA 93711 Indus�tryr��CA 91745 <br /> CAD980887418 CAP99240874 CAD982446992 CAD0000974,12 <br /> Evmyrrrn Env.Svc. ❑ Evorp=Env_Svc. 1:1CPR ❑ CFR ❑ Gtmnlcaf Env.Svc_ <br /> 16604 S.San 7 West Rettrwia 944 P,Slaoson Ave. 33210 Weatem 3474 Toyon Cin:lc <br /> Carson,CA S Maria,CA 93454 Los An�zles,CA%011 Union Ciryry,CA 94587 Valley Spp�as CA 95352 <br /> CA0981 CA 82446858 CA1 DOOI10021 CAL000091507 CALbQ0214d11 <br /> Source: Collection S tion 0 Government Getterator certifies tbat it has ratabliahed a program to reduce the volume or <br /> quantity&toxicity of the hazardous waste to the dcgroc dammmed by <br /> ❑Marine <br /> LJ lcultlllcd ❑Industrial gmcmtor to be ecoaomical]y pro usable. <br /> I hereby certify dW I bane read and have the anthmity to <br /> bind the above Hs%d Wwrator to the terms on the revebe <br /> ;Dn'vi,gnature <br /> ple,# G Z_ side of this form. <br /> nt Vame Route f Date Grme'ra or's Signature Print Name Date <br /> I <br />