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12/16/03 17:25 NORTPn-� FRENCH CAMP 4 2094683433 N0.214 P06 <br /> i <br /> WORK ORDERISERVICE AGREEMENT <br /> Evergreen Environmental Services 102404 <br /> dedicat to the pmtection of the environment <br /> ToSchadle a pickup, call Send payment to: Sales Order# <br /> 800— 72-5284 Evergreen Oil,Inc. <br /> 6860 SmRh Ave,Newark,GA E A#CAD962413262 17ept, 2457 <br /> 16540 S.San Pedro St,Carson, A EPA#GAD9a2413262 Los Angeles, CA 90084-2457 Date- +Z 143 =Z- <br /> G)ENERATORIJOB LOCA ON BILLING INFORMATION <br /> NAME NAME CASH p CHECK d <br /> ADDRESS ADDRESS CUSTOMER CODE NO. <br /> i <br /> CITY STA ZIP CO. CITY STATE ZIP CO. <br /> uF ! Sg°31v�. <br /> PRONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUAMER <br /> Used oil,Non-RCRA Hawdous Lubricating CA221 dC Gal. <br /> Waste,liquid Industrial CA221 Ciel, <br /> A-=r,*-*Avffmu,Na RCRA CA 134 Gal. <br /> wttx Cbin liquid NOS.NA CA2211 <br /> m edwa67n1 a F0g1A2 Gal, <br /> Oil&Water,Nan-RCRA Hazardous[waste Liquid CA221 Gal, <br /> Waste Solids and sludgm Gad, <br /> Wash Gut Each <br /> Drained Used Oil Rtm Drum <br /> Nowt-RCRA Hazatdrws Wasm Solids oily debris) CA223 Drum <br /> Fmpry DruFm Drum <br /> Transportation Hrs. <br /> Non Hazardous Plater GaJ. <br /> =:NCloy D TrLh 4000D pm Q Clor D Tech 1000pf?ass(]Pail Halogen Deteetor/Flatne Test ❑Pass ❑Fail �~ <br /> Field Sc vice Work Description- Total Cllarbes <br /> Qtlxr: <br /> vat; m selAcm rune <br /> Out of Yard On Site Off Site—Off Loan!Start Off Load ad—Return to Yatd <br /> TSDF Consolidated ManifeSt <br /> Evergreen oil,Inc. P n Env.Svc. F-1Evergreen Fov_Svc. ❑ AJS Filter ❑ <br /> IBJ 6$130 Sntith Ave_ Ro -0E 4139 N.Valentine 15131 Clark Ave. <br /> Newark,CA 94560 Da 's,CA 95426 Fresno,CA 93711 Industry,CA 91745 <br /> CAD980887418 82446874 CAD992446882 CAD00009743Z <br /> ❑ Evergreen Env.S Ev teen)illy.Svc. ❑ CFR ❑ CFR ❑ Grranlcaf Env.Svc, <br /> 16604 S.San Padre 745 West Betteravia 944 E.Slauson Ave. 33210 Wostern 3474 Toyon Circle <br /> Carson CA 90746 Sen Maria,CA 93454 Los Angeles,CA 90DII Union City,CA 94587 Valleeyy Springs,CA 95352 <br /> CAD9$1.696420 81446858 CAL.000110021 CALOWD91507 CALt100214411 <br /> Generator ccrdhcs that it has established a program to reduce the volume or <br /> Source: XColleetion S tion 0 Government quantity&laxicity of the hazardous waste to the degree determined by <br /> ❑Marine p 'cultural Q Industrial generator to be economically practicable. <br /> I hereby cerd!y that I have read and have the authority to <br /> bind the above listed generator to the terms on the reverse <br /> Rini/ sample # G side of this form. <br /> Af 4i A <br /> D '`er Signature Print ane. Route# bate enerator's Signature Print Name Date <br />