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WORK ORDERISERVICE AGREEMENT <br /> Evergreen Environmental Services No- 242568 <br /> dedicated to the protection of the environment <br /> To schedule a pickup, call Send payment to: Sales Order OS <br /> 800-972-5284 Evergreen Oil, Inc. <br /> 6880 Smith Ave., Newark,CA EPA#CAD982413262 P.O. BOX 678252 <br /> 16540 S.San Pedro St.,Carson,CA EPA#CAD982413262 Dallas, TX 75267-8252 Date: <br /> GENERATOR/JOB LOCATION BILLING INFORMATION <br /> NAME CASHE] CHECK 0 <br /> # <br /> ADDRESS ADDRESS CUSTOMER CODE NO. <br /> 4#"7 Q 41 CI Y STATE ZIP /CO. 01A&2-V_ <br /> CITY STATE ZIP CO. PO# <br /> PHONE NO. PHONE NO. PROFILENO.No. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER <br /> Used oil,Non-RCRA Hazardous Lubricating CA221 Gal. <br /> Waste,Liquid Industrial CA221 Gal. <br /> Used Automotive Antifreeze,Non-RCRA Hazardous CA 134 Gal. 75--y- <br /> Waste Liquid <br /> RQ Waste Combustible Liquid,N.O.S.NA CA221 Gal. <br /> 1993 In(Oil contaminated with halogens) 17001/1`002 <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA221 Gal. <br /> Waste Solids and Sludges Gal. <br /> -Wash Out Each <br /> Drained Used Oil Filters Drum <br /> Non-RCRA Hazardous Waste Solids(oily debris) CA223 Drum <br /> Empty Drums Drum <br /> Transportation Hrs. <br /> Non Hazardous Water Gal. <br /> TEST:D Clor D Tech 4000-ppm E]Clor D Tech 1000❑Pass❑Fail ❑ Halogen Detector/Flame Test p Ks ❑Fail <br /> Field Service Work Description: Total Charges <br /> Other: <br /> Other: <br /> Vacuum/ervices Time <br /> Out of and On Site_Off Site Off Load Start Off Load End Return to rd <br /> TS E�Consolidated Manifest <br /> ?Evergreen Oil,Inc. F7 Evergreen Env.Svc. ❑ Evergreen Env.Svc. ❑ AJS Filter ❑ <br /> 6880 Smith Ave. Road 30B 4139 N.Valentine 15131 Clark Ave. <br /> Newark,CA 94560 Davis CA 95926 Fresno,CA 93711 Industry,CA 91745 <br /> �14''ou <br /> '7418 <br /> Env. <br /> San P <br /> 9 <br /> ' '_4 <br /> CAD980887418 CAD42446874 CAD982446882 CAD000097432 <br /> ❑ Evergreen Env. c. Ever-reen Env.Svc. CFR F7 CFR Greenleaf Env.Svc. <br /> 16604 S.San P ro 745 'A West Betteravia 1:1 944 E.Slauson Ave. " 33210 Western F❑ <br /> 3474 Toyon Circle <br /> Carson, <br /> arson,CA 9 46 Santa Maria,CA 93454 Los Angeles,CA 90011 Union City,CA 94587 Valley Springs,CA 95352 <br /> CAD98169 0 CAD982446858 CAL0001 10021 CAL000091507 CAL000214411 <br /> Generator certifies that it has established a program to reduce the volume or <br /> Source: Collection Station J Government quantity&toxicity of the hazardous waste to the degree determined by <br /> U Marine J Agricultural..Lj Industrial generator to be economically practicable. 0 <br /> I hereby certify that I have read and have the authority L- <br /> bind the above listed generator to the terms on the reverse <br /> R <br /> sill sample # CZ. side of this form. <br /> L <br /> o <br /> r7/ I*"*%— <br /> A. 2 n1 . fvw� <br /> 7er7ignaturet/7riTt Name Route# 15ate a or's Signature Print Name Date <br />