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12/16/03 17:25 NORTRQX FRENCH CAMP 4 2094693433 NO.214 P14 <br /> I <br /> WORK QRDERISERVICE AGREEMENT <br /> ' Evergreen nvironmental Services N° 15 7 8 2 8 <br /> dedtcared to rhe protection.of the envirotiment <br /> To sched e a pickup, call Send payment to: Sales Order # <br /> 800' 72-5284 Evergreen Oil,Inc. <br /> aaso Smith Ave.,Ntrwark,CA EP CA0932413262 Dept. 2457 <br /> t6sao 5-San Pedro St.,Gerson,CEPA#CAD9824132e2 Los Angeles,CA 90084-2457 Date: <br /> GENERATOR/JOB LOCA ON BILLING INFORMATION <br /> N4MA NAME CASH❑CHECK I] <br /> ADDRESS ADDRESS CU MER CODE NO. <br /> r a <br /> CrrY STA ZIP Co. CrrY STATE zrP CO. (3 � I <br /> HONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> . 9�3 Z c44'Lappjt7f#Q <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used nil,Nan-RCRA Herarclous Lulric.ting CA221 B Gal. L S1 �'CS0 <br /> V hitt,Ligtud Industdai CA221 Gal. <br /> Used Aviammi.e Artlifieve,N—RCRA H­Tdu, CA 134 Gal. <br /> w•r�t <br /> R w.sm CeeNorfille[lgme NA.a.NA cx2� Gal. <br /> �s m oa oa=n<n.aa Fai, <br /> ."I 1�onJrr-0a2 <br /> oil&Waier,Non-RCRA Hazardous este Liquid CA221 Gal, <br /> Waste Solids and Sludges 041- <br /> Wash out Each <br /> Drained Used Oil Filter; Drum <br /> ?Von-RCRA Hamrdous Waste Solids( ily debris) CA223 Dnim <br /> E pty Drums Drum <br /> Transportation Hrs. <br /> Non H s Water Gal- <br /> TF,ST: Clor D Tech 4n) 2 m ❑Oor 1)Tech 1000 Pess❑Ful ❑ Halogen DetectorMifne ' st ❑Pass ❑Fail Zoe � <br /> Fod Service Work Description Totdl Charges <br /> i <br /> joR1,er <br /> 0�]ter. <br /> vacuum Services Time <br /> Out of Yard On Site Off Site-Off Load Start Off Load End Retum to Yard 7, <br /> TSDF Colndolidated Mani st <br /> j Evergreen Oil,Inc. Ever ecn Env.Svc. Evcv"rn Env,Svc, AJS Filtor <br /> 6880 Smith Ave. Raa 3M 4139 N.Valentine 15131 Clark Ave. <br /> NewaT],CA 94560 Devi,CA 95926 Fresno,CA 93711 Tndustry,CA 91745 <br /> CAAg80887418 C 82446814 CAD982446882 C.AD000097432 <br /> l Evergreen Env. Ever reen Env,Svc, ❑� CFR n CFR Gre <br /> 1f+G04 S.San P >a 745 Wear I3cucravis 944 L.5lnuson Ave. a 3321.0 Western l__1 3475 Taayyon /rete <br /> Carson,CA 9 46 San Mmia,CA 93454 Los Angeles.CA 90011 Union City,CA 94587 Valley Spr,nss,CA 95352 <br /> CAD9916 D CA 82146856 CALOOOl10021 CAL000091507 CAL00014d11 <br /> Generator cm ues duet i[has established a program to rcdvee the volume Or <br /> Source: Uj Collection Sttion ❑Government qunntiry&toxicity of the hazardous waste to the degree determined by <br /> 6 Ca Marine ❑fi riet1ltural ]Tndusui�d generotor to be economically practicahle. <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 /> R.' in Sample side of this form. <br /> Dr r Signature rent 1 ame Route# ate aerator's Signature Print Name Date <br /> I <br /> �, - � 3—� <br />