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12/16/03 17:25 NORTP-'y FRENCH CAMP 4 2094683433 NO.214 907 <br /> WORK ORDERISERVTCE AGREEMENT <br /> Evergreen nvironmental Services N° 1.06675 <br /> dea7tA7e JO rhe profecfiery orn <br /> f the environenf <br /> To schaad le a pickup, call Send payment to: Sales Order# <br /> 8100- 72-5284 Evergreen Oil,Inc. <br /> 6880 Smith Ave.,Nomwarit,CA EP CAD962413262 Dept. 2457 <br /> 16540 S. San Pedro$t.,Gar50n, EPA#GAI)98241 aa6e Los Angeles,CA 90084-2457 Date: 11 jy 3 <br /> GENERATOPWWOU LOCA ON BILLING INFORMATION <br /> NAME � NAAfE CASH L]C$.ECK(] <br /> aftG # <br /> ADD AD KESS CUSTOMER CODE NO. <br /> eaIT STAIE zrP CO. CITY STA'T'E ZIP CO. PO <br /> gtgs6g" C4 %Z31 �Y2 <br /> ONE NO. PHONE NO, PRO)ETI.E NO. CUSTOMER EPA ID NO. <br /> 2ZILA <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE N 13MB E R <br /> Uscd oil,Non-RCRA Hazardous Lubricating CA221 Gal. Z% "+ <br /> Wase,Liquid Industrial, CA221 Gal. <br /> =AIID0c1 ivt A ff—Na.acgn Frazz&u CA134 Gal <br /> UO W—Cwcbx6bbt L 9.0 H.O.S.NA CA71r Gal. <br /> 1 3 m 1 pu mmmaea w fano r FOfJS <br /> 0u1&Water,Non-RCRA Hazardous bUate Liquid CA221 Gal. <br /> Waste Solids mad Sludges Cyril. <br /> Wasb Out Fath <br /> Dwund U6cd Oil Filters Drum <br /> Non-RCRA Hwardom Waste Solids oily debris) CA223 Drum <br /> Ln'm Daum Drum <br /> Trarraportation Hrs. <br /> Non tlazardma Vater Gal, <br /> TM:RCIor D Tech ❑Clor D Tech 100DRFass ❑Fail [] Halogen Detector/Maim Ica ©Pass Fail <br /> Fuld Service Wort:Description: Total Charges <br /> Odtcr: <br /> Outer <br /> vacuum services Tion / <br /> Oor of Yard On Site off Site Off Load Start Off Load U Retmn to tad 1p `� <br /> TSDF FCOnsofidated Manifest <br /> vagreen Oil,Ire_ ❑ Ev en Env.Sve, Evergreen Env.Svc. (� AJS Filter <br /> Irl 6880 Sfttith Ave, 3011 4139 N.Valeadue 1.1 15131 Clerk Ave, <br /> Ncwmk.CA 94560 Da s,CA 95926 Fmrio,CA 93711 Industry CA 91745 <br /> CAD98089741b C 82446874 CAD982446992 CAD000097432 <br /> Evargrccu r v.Svc: Ev teen Env.Svc CPR CFR Grccnicaf Env.Svc. <br /> 16604 S.Sen Pedro! 745 A West Retteravia 944 E.Slauson Ave, 33210 Western 3474 Toyon Circle <br /> Carson,CA 90746 San Maria,CA 93454 Los Angeles,CA 90011 Union City.CA 94587 Val�leyy�Springs,CA 95352 <br /> cj0"1696420 2446858 CALOODII0021 CAL00009150'7 CALW02,14411 <br /> �-t1 <br /> Gettera[nr certifies that It bas established a program to mdnez the volume or <br /> Source: Wollecfion St tion J Gove Ment quantity&toxicity of the hazardous waste to the degree dctcrmincd by <br /> Q Marine f] 'Cultural ❑ industrial generaror to be xoJtomically practicable <br /> I here_by cedb that I have read and have the authority to <br /> hind the above listed generator to the terms on the reverse <br /> twin sample# 3 side of this form. <br /> ver Signature Print alne Route# Date rG6eratorT& Signature Print Name Date <br /> i <br />